Clinical Assistant Professor and Neurosurgeon University of Calgary Calgary, AB, CA
Disclosure(s):
Michael Yang, MD, MSc, M.Biotech: No relevant disclosure to display
Introduction: Urinary catheters are used due to surgery duration and need to monitor urinary output intraoperatively. The ERAS Society consensus statement on perioperative care in lumbar spinal fusion recommends against routine use of urinary catheters for short-segment fusion, and supports catheter removal within hours after surgery. The present study evaluated whether a quality improvement initiative improved early catheter discontinuation after lumbar fusion surgery.
Methods: A current-state review, including process mapping and root cause analysis, was completed with nurse and surgeon stakeholders to identify practices for catheter insertion and removal, and determine key factors contributing to delayed catheter removal. Five plan-do-study-act cycles were completed, which informed the composite intervention of postoperative order set standardization, surgeon report cards to highlight performance variations, and surgeon education. The primary outcome (catheter compliance) was catheter removal within 24-hours after surgery. Secondary outcomes included proportion of insertions, time to catheter removal, urinary tract infections (UTI), and length of hospital stay (LOS). Univariable analyses and multivariable logistic regression models were used to evaluate the effectiveness of our intervention.
Results: 438 patients underwent lumbar fusion surgery, 320 in the pre-intervention cohort and 118 in the post-intervention cohort. The current state analysis highlighted barriers to early catheter removal once the patient reached the inpatient ward. As such, our intervention included surgeon education, focused on catheter removal in the operating room. Our intervention resulted in a significant increase in the proportion of catheters removed within 24-hours (85.6% vs. 63.8%, p=0.001). Time to catheter discontinuation was reduced from 21.3 to 14.9 hours (p < 0.001). Proportion of catheters removed in the operating room increased from 41.0% to 60.2% (p=0.012). There was no difference in catheter utilization (p=0.26), re-insertion rates (p=0.89), and UTI (p=0.46). LOS was shorter in patients who achieved catheter compliance (3.4 days vs. 6.9 days, p< 0.001). Multivariable analysis showed catheter compliance was independently associated with the quality improvement intervention (OR 3.8, p< 0.001), age (OR 0.98, p=0.018), female sex (OR 0.52, p=0.006), and surgical time (OR 0.61, p< 0.001).
Conclusion : Our quality improvement intervention independently improved catheter compliance. Early catheter discontinuation led to reduced LOS after elective lumbar fusion.