Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method

Jennifer Meddings; Ted A Skolarus; Karen E Fowler; Steven J Bernstein; Justin B Dimick; Jason D Mann; Sanjay Saint

doi:10.1136/bmjqs-2018-008025

Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND/UCLA Appropriateness Method

BMJ Qual Saf. 2019 Jan;28(1):56-66. doi: 10.1136/bmjqs-2018-008025. Epub 2018 Aug 12.

Authors

Jennifer Meddings^{1

2

3}, Ted A Skolarus^{1

4}, Karen E Fowler¹, Steven J Bernstein^{1

2

5}, Justin B Dimick^{5

6}, Jason D Mann², Sanjay Saint^{1

2}

Affiliations

¹ VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
² Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
³ Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁴ Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
⁵ Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.

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.

Keywords: healthcare quality improvement; nosocomial infections; patient safety.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Female
General Surgery*
Guidelines as Topic
Humans
Male
Medical Audit
Michigan
Orthopedic Procedures*
Perioperative Care*
Unnecessary Procedures
Urinary Catheterization* / statistics & numerical data

Grants and funding

K08 HS019767/HS/AHRQ HHS/United States