Impact of Institutional Protocol on Urinary Catheter Outcome Measures in Orthopedic Children Treated With Epidural Analgesia

Background Epidural analgesia is commonly used for pain control after major lower‐limb orthopedic surgery in children, but it is associated with a risk of postoperative urinary retention. Consequently, urinary catheters are often placed and left in situ for the full duration of epidural analgesia, despite the potential risks of prolonged catheterization, including discomfort, ward reinsertion, and urinary tract infection. Aims To assess the impact of implementing a standardized institutional urinary catheter management protocol on postoperative urinary catheter outcomes in children less than age 18 years, undergoing major lower‐limb orthopedic surgery with postoperative epidural analgesia. Methods Single‐center, retrospective, observational study on children who met the above criteria in the study period before (1/2019–6/2021) and after (7/2021–7/2023) initiation of a urinary catheter management protocol. The protocol mandated intra‐operative urinary catheter placement and early removal on postoperative day 1, while continuing epidural analgesia as long as 5 days. Results A total of 93 children were included in this study: 47 before and 46 after initiation of the protocol. Demographic data were similar. Children treated according to the new protocol required significantly fewer ward urinary catheter insertions (2.2% vs. 19.1% respectively, p = 0.003) and had significantly faster removal of urinary catheter (1 [1‐1] vs. 3 [2‐3] days, p < 0.001) without subsequent urinary catheter insertion despite similar epidural analgesia duration. There was no difference in occurrence of urinary tract infection. Conclusions Implementation of a standardized institutional urinary catheter management protocol, mandating intraoperative catheter placement and removal on postoperative day 1, despite ongoing epidural analgesia, was associated with reduced urinary catheter duration and fewer postoperative ward catheter insertions in pediatric patients undergoing major lower‐limb orthopedic surgery.