You are here

  • Home
  • Archive
  • Volume 28, Issue 1
  • Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method

Article Text

Article menu

Download PDFPDF

Original research
Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method
  1. Jennifer Meddings1,2,3,
  2. Ted A Skolarus1,4,
  3. Karen E Fowler1,
  4. Steven J Bernstein1,2,5,
  5. Justin B Dimick5,6,
  6. Jason D Mann2,
  7. Sanjay Saint1,2
  1. 1 VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  4. 4 Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
  5. 5 Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
  6. 6 Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer Meddings, Department of Internal Medicine University of Michigan Medical School Ann Arbor Michigan USA; meddings{at}umich.edu

Abstract

Background Indwelling urinary catheters are commonly used for patients undergoing general and orthopaedic surgery. Despite infectious and non-infectious harms of urinary catheters, there is limited guidance available to surgery teams regarding appropriate perioperative catheter use.

Objective Using the RAND Corporation/University of California Los Angeles (RAND/UCLA) Appropriateness Method, we assessed the appropriateness of indwelling urinary catheter placement and different timings of catheter removal for routine general and orthopaedic surgery procedures.

Methods Two multidisciplinary panels consisting of 13 and 11 members (physicians and nurses) for general and orthopaedic surgery, respectively, reviewed the available literature regarding the impact of different perioperative catheter use strategies. Using a standardised, multiround rating process, the panels independently rated clinical scenarios (91 general surgery, 36 orthopaedic surgery) for urinary catheter placement and postoperative duration of use as appropriate (ie, benefits outweigh risks), inappropriate or of uncertain appropriateness.

Results Appropriateness of catheter use varied by procedure, accounting for procedure-specific risks as well as expected procedure time and intravenous fluids. Procedural appropriateness ratings for catheters were summarised for clinical use into three groups: (1) can perform surgery without catheter; (2) use intraoperatively only, ideally remove before leaving the operating room; and (3) use intraoperatively and keep catheter until postoperative days 1–4. Specific recommendations were provided by procedure, with postoperative day 1 being appropriate for catheter removal for first voiding trial for many procedures.

Conclusion We defined the appropriateness of indwelling urinary catheter use during and after common general and orthopaedic surgical procedures. These ratings may help reduce catheter-associated complications for patients undergoing these procedures.

  • healthcare quality improvement
  • nosocomial infections
  • patient safety

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2018-008025

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors JM and KEF had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JM, TAS, KEF, SJB, JD, SS. Acquisition of data: JM, KEF, TAS, SJB, JDM. Analysis and/or interpretation of data: JM, KEF, SJB, JD, SS. Drafting of the manuscript: JM, KEF, JDM. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: KEF. Obtaining funding: JM, SS. Study supervision: JM, TAS, SS.

    • Funding This project was funded by a contract from the Agency for Healthcare Research and Quality (AHRQ) (contract HHSA2902010000251/HHSA29032001T). Additional support was received from the University of Michigan and the Department of Veterans Affairs National Center for Patient Safety, Ann Arbor Patient Safety Center of Inquiry. Dr. Meddings' effort on this project was funded by concurrent support from AHRQ (K08 HS19767) and Dr. Skolarus' effort was funded by concurrent support from the Department of Veterans Affairs Health Services Research and Development (CDA 12-171).

    • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services, or the Department of Veterans Affairs.

    • Competing interests JM has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. SS has reported receiving honoraria for lectures and teaching related to prevention of catheter-associated urinary tract infection, and is on the medical advisory boards of Doximity and Jvion.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement All data are included in the online supplementary appendix.