Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero

Surgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero.

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Encounter, Performed: Encounter Inpatient

None

None

None

It is well-established that the risk of catheter-associated urinary tract infection (UTI) increases with increasing duration of indwelling urinary catheterization. In 2000, Saint reported the results of a pooled analysis of 10 prospective trials dating from 1983 to 1995 which estimated that bacteriuria will develop in 26% of patients after 2 to 10 days of catheterization (95% CI 23-25%). Additional pooled analyses demonstrated that 24% (95% CI 16% to 32%) of those patients will develop symptomatic UTI and bacteremia will develop in 3.6%. Among surgical patients, two studies of postoperative patients discharged to subacute care with urinary catheters were more likely to be readmitted to the hospital with a UTI compared with those who had catheters removed prior to hospital discharges (Wald, 2005 and Wald, 2008). Among selected major surgical patients in the Surgical Infection Project (SIP) cohort, Wald demonstrated (in press) that 85% had perioperative indwelling catheters placed and half of those patients had catheters for greater than 2 days postoperatively. These patients were twice as likely to develop UTIs prior to hospital discharge. On multivariate analysis, those who had indwelling bladder catheters for more than 2 days postoperatively were 21% more likely to develop UTI, significantly less likely to be discharged to home, and had a significant increase in mortality at 30 days. Additional analyses suggest that there is sizeable variation in the duration of postoperative catheterization among hospitals and that hospital factors may account for this variation. In 2006, Stephan reported the results of a multifaceted intervention study in orthopedic surgery patients in which protocols limiting the use and duration of postoperative catheterization played a large role. They reported a resultant 60% reduction in UTI incidence-density.

Minimizing the duration of indwelling urinary catheterization can reduce the risk of catheter-associated urinary tract infection.

Improvement noted as an increase in rate.

Saint S. Clinical and economic consequences of nosocomial catheter-related bacteremia. Am J Infect Control 2000; 28: 68-75.

Stephan F, Sax H, Wachsmuth M, et al. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective before-after study. Clin Infect Dis. 2006; 42; 1544.

Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling Urinary Catheter Use in the Postoperative Period: Analysis of The National Surgical Infection Prevention Project Data. Arch Surg. In press.

Wald H, Epstein A, Kramer A. Extended Urinary Catheterization Among Hip Fracture Patients Discharged to Skilled Nursing Facilities. Med Care 2005; 43:1009-1017.

Wald HL, Epstein AM, Radcliff TA, Kramer AM. Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem? Infect Cont Hosp Epidemiol 2008; 29:116-124.

Initial Population(s): All hospital discharges for selective surgery with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission with a catheter in place postoperatively.

The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 = Oct - Dec.

Denominator element guidance:

The denominator in this measure specifically excludes surgical procedures that may be associated with post-operative indwelling urinary catheter usage and that occur in close time proximity to the index major surgical procedure.

TBD

All hospital discharges for selective surgery with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission and who have a Principal Procedure Code of selected surgeries.

All selected surgical patients 18 years of age and older with a catheter placed between hospital arrival and the end of the recovery period, defined as within 6 hours after the end of anesthesia for a SCIP selected surgery as defined in the Initial Population.  The catheter must still be in place after the end of the recovery period.

Patients who had a urological, gynecological or perineal procedure performed. 
Patients who expired perioperatively. 
Patients whose length of stay was less than two days postoperatively. 
Patients who had a urinary diversion or a suprapubic catheter or were being intermittently catheterized prior to hospital arrival.
Patients who did not have a catheter in place postoperatively. 
Patients who had physician/APN/PA documentation of a reason for not removing the urinary catheter postoperatively.
In ICU on POD 1 or POD 2 AND receives at least one or more dose(s) of one or more of the following medications:
     * Diuretic
     * Vasopressor/inotropic
     * Paralytic

Number of surgical patients whose urinary catheter is removed on postoperative day (POD) 1 or postoperative day (POD) 2 with day of surgery being day zero.

Not applicable

None

Not applicable

Not applicable

Not applicable

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Surgical Care Improvement Project (SCIP)