Elective caesarean section without routine indwelling bladder catheterization – impact on mobilization and patient satisfaction

Background Global caesarean section rates have continuously increased. Therefore, a remarkable number of women could benefit from Enhanced Recovery After Surgery (ERAS ® ) protocol aiming to reduce perioperative stress and achieve early recovery. In 2019 the ERAS ® protocol for caesarean section was initiated in the Helsinki University Women’s Hospital and the Espoo Delivery Hospital in Finland. Among other improvements, the routine use of indwelling urinary catheter was discontinued among healthy women with no significant preoperative risk factors. Methods This retrospective case-control study was carried out at the Espoo Hospital in Finland. Data were collected retrospectively from the hospital’s electronic patient information system. The study included 208 women undergoing full term elective caesarean section. Group 1 ( n = 104) routinely had an indwelling urinary catheter placed: half of them had no pre-specified time for catheter removal ( n = 52) and half of them had an indwelling urinary catheter placed for 8 to 12 h ( n = 52). Group 2 ( n = 104) had a perioperatively placed urinary catheter only if needed. The primary outcome was the time from the end of the operation to patient mobilization, while secondary outcomes were the length of hospital stay and overall patient satisfaction. Results Group 2 without a routine indwelling urinary catheter had a significantly shorter median time to mobilization (median = 5.8 h) than group 1 (median = 9.1 h) p < 0.001. In the multivariable analysis, the absence of the urinary catheter was the strongest factor associated with earlier mobilization. There was no difference in length of hospital stay, patient satisfaction or intraoperative blood loss between the groups and no bladder injuries were recorded. Conclusion Patients without a routine indwelling urinary catheter mobilized significantly faster compared to patients with a routinely placed urinary catheter. We found no difference in length of stay or patient satisfaction between the groups. These results support limiting the routine use of indwelling urinary catheter among healthy women undergoing caesarean section.