Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia
Purpose: Epidural analgesia (EA) is commonly employed for postoperative pain management in children undergoing abdominal tumor resection. Indwelling urinary catheters (IUCs) often remain for the duration of EA administration due to concern for associated urinary retention. This study focuses on chil...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Journal of Pediatric Surgery Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949711624000765 |
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| author | Shachi Srivatsa Jennifer H. Aldrink Dana Schwartz Grant Heydinger Andrew Davidoff Andrew J. Murphy Kyle O. Rove Sara A. Mansfield |
| author_facet | Shachi Srivatsa Jennifer H. Aldrink Dana Schwartz Grant Heydinger Andrew Davidoff Andrew J. Murphy Kyle O. Rove Sara A. Mansfield |
| author_sort | Shachi Srivatsa |
| collection | DOAJ |
| description | Purpose: Epidural analgesia (EA) is commonly employed for postoperative pain management in children undergoing abdominal tumor resection. Indwelling urinary catheters (IUCs) often remain for the duration of EA administration due to concern for associated urinary retention. This study focuses on children undergoing abdominal tumor resection with appropriate EA coverage, to assess whether IUC can be removed early with minimal risk of reinsertion for urinary retention. Methods: A retrospective review of children who underwent abdominal tumor resections with EA between 2015 and 2023 at two institutions was conducted. Data were summarized, and rates of postoperative urinary retention requiring catheter reinsertion and catheter-associated urinary tract infections (CAUTIs) were compared between patients with early and late IUC removal groups using Fisher's exact testing. “Early” was defined as IUC removal with EA in place and “late” as IUC removal after or concurrent with EA discontinuation. Results: A total of 228 children underwent abdominal tumor resections with EA. Of these, 104 had early, and 124 had late IUC removal. The average postoperative day (POD) of IUC removal in the early group was 1.1±0.5 days and 2.9±1.1 days in the late group. EA was at T12 level or higher in 101 patients (97.1 %) in the early group, and 68 (54.8 %) in the late group (p<0.001). EA contained opioids in 27 (26.0 %) in the early group and 54 (43.5 %) in the late group (p=0.005). There were 6 (5.8 %) children in the early group and 1 (0.8 %) in the late group requiring re-catheterization (p = 0.049). For those requiring re-catheterization, the EA level was T7-8 in 5 patients, T10-11 in 1 patient, and T4 in 1 patient (late). There was 1 (1.0 %) patient with a CAUTI in the early group, and 3 (2.4 %) patients in the late group (p = 0.63). Conclusions: Early removal of indwelling urinary catheters in the setting of thoracic epidural analgesia is associated with a small risk of urinary retention necessitating catheter re-insertion. Balancing the need for IUCs with this possibility, patient comfort, and infectious risk should inform decision-making to best align with enhanced recovery efforts. |
| format | Article |
| id | doaj-art-779b7d352efd4715abae0f962c61b206 |
| institution | Kabale University |
| issn | 2949-7116 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Open |
| spelling | doaj-art-779b7d352efd4715abae0f962c61b2062025-01-22T05:44:37ZengElsevierJournal of Pediatric Surgery Open2949-71162025-01-019100191Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesiaShachi Srivatsa0Jennifer H. Aldrink1Dana Schwartz2Grant Heydinger3Andrew Davidoff4Andrew J. Murphy5Kyle O. Rove6Sara A. Mansfield7Center for Surgical Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United StatesDepartment of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United StatesDepartment of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United StatesDepartment of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United StatesDepartment of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, United StatesDepartment of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, United StatesDepartment of Pediatric Urology, Children's Hospital Colorado, Aurora, Colorado, United StatesDepartment of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, United States; Corresponding author at: Division of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, Ohio, United StatesPurpose: Epidural analgesia (EA) is commonly employed for postoperative pain management in children undergoing abdominal tumor resection. Indwelling urinary catheters (IUCs) often remain for the duration of EA administration due to concern for associated urinary retention. This study focuses on children undergoing abdominal tumor resection with appropriate EA coverage, to assess whether IUC can be removed early with minimal risk of reinsertion for urinary retention. Methods: A retrospective review of children who underwent abdominal tumor resections with EA between 2015 and 2023 at two institutions was conducted. Data were summarized, and rates of postoperative urinary retention requiring catheter reinsertion and catheter-associated urinary tract infections (CAUTIs) were compared between patients with early and late IUC removal groups using Fisher's exact testing. “Early” was defined as IUC removal with EA in place and “late” as IUC removal after or concurrent with EA discontinuation. Results: A total of 228 children underwent abdominal tumor resections with EA. Of these, 104 had early, and 124 had late IUC removal. The average postoperative day (POD) of IUC removal in the early group was 1.1±0.5 days and 2.9±1.1 days in the late group. EA was at T12 level or higher in 101 patients (97.1 %) in the early group, and 68 (54.8 %) in the late group (p<0.001). EA contained opioids in 27 (26.0 %) in the early group and 54 (43.5 %) in the late group (p=0.005). There were 6 (5.8 %) children in the early group and 1 (0.8 %) in the late group requiring re-catheterization (p = 0.049). For those requiring re-catheterization, the EA level was T7-8 in 5 patients, T10-11 in 1 patient, and T4 in 1 patient (late). There was 1 (1.0 %) patient with a CAUTI in the early group, and 3 (2.4 %) patients in the late group (p = 0.63). Conclusions: Early removal of indwelling urinary catheters in the setting of thoracic epidural analgesia is associated with a small risk of urinary retention necessitating catheter re-insertion. Balancing the need for IUCs with this possibility, patient comfort, and infectious risk should inform decision-making to best align with enhanced recovery efforts.http://www.sciencedirect.com/science/article/pii/S2949711624000765Epidural analgesiaIndwelling urinary catheterEnhanced recovery after surgeryPost-operative careUrinary retention |
| spellingShingle | Shachi Srivatsa Jennifer H. Aldrink Dana Schwartz Grant Heydinger Andrew Davidoff Andrew J. Murphy Kyle O. Rove Sara A. Mansfield Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia Journal of Pediatric Surgery Open Epidural analgesia Indwelling urinary catheter Enhanced recovery after surgery Post-operative care Urinary retention |
| title | Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| title_full | Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| title_fullStr | Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| title_full_unstemmed | Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| title_short | Early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| title_sort | early removal of indwelling urinary catheters in children undergoing abdominal tumor resection with epidural analgesia |
| topic | Epidural analgesia Indwelling urinary catheter Enhanced recovery after surgery Post-operative care Urinary retention |
| url | http://www.sciencedirect.com/science/article/pii/S2949711624000765 |
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