Safety and satisfaction of urinary catheter use in the perioperative period amongst hip fracture patients: a prospective cohort.

INTRODUCTION Foley catheterization is often performed at time of admission in patients suffering a hip fracture. Guidelines for catheter management are inconsistent and lack consideration of the patient experience. We aimed to compare pain and convenience with voiding, as well as complication rates (urinary tract infection (UTI), postoperative urinary retention (POUR), and surgical site infection (SSI)) of catheterized versus non-catheterized patients awaiting hip fracture surgery.

METHODS Patients admitted to a single tertiary care hospital with a hip fracture completed a 3-item questionnaire about their preoperative bladder management experience. The primary outcome was pain associated with catheterization versus non-catheterization. Secondary outcomes included rates of postoperative UTI, POUR and SSI.

RESULTS A total of 119 patients were included. Fifty-five (93.2%) catheterized patients found the catheter to be convenient and only 6 (10.2%) reported pain with catheter use. Conversely, 28 (46.7%) non-catheterized patients found it painful to move to the bathroom and 17 (28.3%) reported pain with urination. Catheterized patients had significantly less pain related to emptying their bladder than non-catheterized patients (0.90/10 vs 3.59/10, respectively; p < 0.001). The rate of UTI (18.6% catheterized vs 13.3% non-catheterized), POUR (6.8% catheterized vs 11.1% non-catheterized) and SSI (3.4% catheterized vs 1.7% non-catheterized) were similar between groups.

CONCLUSIONS Preoperative catheter use was associated with less pain with voiding and greater satisfaction for patients awaiting hip fracture surgery, without increasing rates of postoperative UTI, POUR, or SSI. Guidelines for catheter use should consider the patient experience.

LEVEL OF EVIDENCE II.