Early Foley catheter removal in thoracic surgical oncology patients receiving epidural analgesia

Background: Historically, it has been assumed that indwelling urinary catheters used to prevent urinary retention in patients undergoing epidural analgesia should be left in for the duration of the epidural analgesia. Our institution initiated an early Foley removal (EFR) program in thoracic surgical oncology patients to remove indwelling catheter while the epidural analgesia was still in place, 24–72 h after surgery. The objective of this study was to evaluate the feasibility of EFR in terms of rate of re-catheterization, urinary tract infections (UTI), or the length of hospital stay (LOS). Methods: We reviewed the medical records of 99 thoracic surgical oncology patients who underwent EFR with indwelling epidural analgesia from May 2012 to February 2013. The main outcome variable was re-catheterization incidence. We also compared a propensity matched subgroup of patients who had undergone surgery prior to the institution of EFR. The outcome variables for this group were the rate of UTI and LOS. Results: In the EFR group (N = 99), the median duration of Foley catheterization was 40 h. Sixteen (16%) patients experienced difficulty voiding within 8 h of catheter removal, 8 required re-catheterization (8%). In the propensity-matched analysis, there was no difference in the rate of UTI between the two groups (1% in both groups). Conclusions: EFR was associated with a low re-catheterization rate. Our findings support the CDC's recommendation to remove catheters early in thoracic surgical oncology patients. EFR will promote patient comfort and may play an important role in improving the postoperative care in thoracic oncology patients.