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Early removal of urinary drainage in patients receiving epidural analgesia after colorectal surgery within an ERAS protocol is feasible

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Abstract

Background

ERAS guidelines recommend early removal of urinary drainage after colorectal surgery to reduce the risk of catheter-associated urinary tract infections (CAUTI). Another recommendation is the postoperative use of epidural analgesia (EA). In many types of surgery, EA was shown to increase the risk of postoperative urinary retention (POUR). This study determines the impact of early urinary catheter removal on the incidence of POUR and CAUTI under EA after colorectal surgery.

Methods

Eligible patients were scheduled for colorectal surgery within the local ERAS protocol between April 2015 and September 2016. Urinary drainage was removed on the first postoperative day while EA was still in place (early removal group (ER)). The incidences of POUR and CAUTIs were recorded prospectively. Results were compared with a historical control (CG), which was operated between October 2013 and March 2015.

Results

POUR occurred significantly more often in the ER (ER 7.8%; CG 2.6%), while CAUTIs were significantly less frequent in the ER (13.8%) compared with the CG (30.4%). Patients who developed POUR were characterised by a significantly higher rate of abdominoperineal resections, by a higher frequency of rectal cancer, and a higher male-to-female ratio compared with patients who did not develop POUR.

Conclusion

Early removal of urinary drainage after colorectal surgery while EA is still in place is feasible; it reduces the incidence of CAUTI but increases the risk of POUR. Thus, screening for POUR in patients with failure to void after six to 8 h is mandatory under these clinical conditions.

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Authors and Affiliations

  1. Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany

    André Schreiber, Emine Aydil, Uwe Walschus, Anne Glitsch, Maciej Patrzyk, Claus-Dieter Heidecke & Tobias Schulze

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Contributions

André Schreiber: conception of the work, interpretation of the data, revising the manuscript for important intellectual content. Emine Aydil: conception of the work, data acquisition, revising the manuscript for important intellectual content. Uwe Walschus: analysis, interpretation of the data, revising the manuscript for important intellectual content. Anne Glitsch: data acquisition, revising the manuscript for important intellectual content. Maciej Patrzyk: data acquisition, revising the manuscript for important intellectual content. Claus-Dieter Heidecke: conception of the work, revising the manuscript for important intellectual content. Tobias Schulze: conception of the work, data acquisition, analysis, interpretation of the data, drafting the work. All authors listed above approved the version submitted and agree to be accountable for all aspects of the work. In addition, they will ensure that questions regarding the accuracy and integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Tobias Schulze.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethical Committee of the Universitätsmedizin Greifswald (reference number: BB075/16)

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Schreiber, A., Aydil, E., Walschus, U. et al. Early removal of urinary drainage in patients receiving epidural analgesia after colorectal surgery within an ERAS protocol is feasible. Langenbecks Arch Surg 404, 853–863 (2019). https://doi.org/10.1007/s00423-019-01834-6

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