The Effect of Bladder Catheterization on Ambulation and Venous Thromboembolism Following Total Knee Arthroplasty: An Institutional Analysis

Abstract

Background: Although intermittent catheters are immediately removed, indwelling catheterization may lead to decreased ambulation and participation in physical therapy, critical components to post-total knee arthroplasty (TKA) management. Therefore, this study aimed to compare the effect of catheterization treatments on (1) postoperative ambulation distances, (2) deep vein thromboses (DVTs), and (3) pulmonary emboli (PEs) following TKA. Methods: A total of 9123 prospectively collected primary TKA patients were assessed based on postoperative catheter status. Patient demographics, Charlson Comorbidity Indices, body mass indices, DVT prophylaxes, first ambulation distances, DVTs, and PEs were collected at approximately mean 12 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models in order to compare catheterization techniques. Results: There were 1193 patients who had urinary retention and treated with either indwelling only (62%, n ¼ 734), both indwelling and intermittent catheterizations (13%, n ¼ 160), or intermittent only (25%, n ¼ 299). Multivariate analyses found that indwelling catheter-only use had an 11% decrease in ambulation distance (P < .001). Additionally, the indwelling catheterization-only group was found to be at increased risk of DVTs (odds ratio 2.605, P < .001), even after controlling for DVT prophylaxes (odds ratio 2.807, P < .001). Conclusion:This study showed that the use of an indwelling catheter for treatment of urinary retention significantly decreased TKA patient ambulation distance and subsequently increased the risk for DVTs. This information is important as we would recommend the treatment with intermittent catheterization rather than indwelling catheters to decrease the risk of immobilization and postoperative DVTs.

Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study

“…Additionally, less indwelling catheter time should theoretically decrease rate of postoperative urinary tract infections. Patients also ambulate less with a catheter in place, 16 , 17 which has the potential to increase the risk for postoperative deep venous thrombosis. Catheter dysfunction is also a postoperative issue, causing for patient concern and unintended emergency room visits for clogging and/or poor drainage.…”

Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital

“…Furthermore, there was a notable reduction in the usage of indwelling catheters in the RRP group (39.0% versus 98.0%), which has been correlated with increased postoperative urinary traction infections, higher hospital costs, and decreased postoperative ambulation distance after TJA. 35,36 In addition, the use of closed suction drains markedly decreased in the RRP group (20.4% versus 94.5%), which has been previously correlated with a greater need for transfusion postoperatively. 37,38 To further limit blood loss and transfusion requirement, intravenous TXA was also administered TXA intraoperatively.…”

Should urinary catheters be avoided in patients with total joint arthroplasty?

“…6 Studies involving 7,306 patients undergoing THA and 9,123 undergoing TKA evaluated the risk of postoperative UTI, postoperative mobility, and the development of POUR in patients with and without indwelling urinary catheters. 7,8 The authors concluded that postoperative UTI was significantly higher in the catheter group compared with the noncatheter group (P < .001), and if POUR developed, intermittent catheterization was favored over indwelling catheterization. 7,8 In the TKA cohort, indwelling catheterization delayed mobility and ambulation distance, and consequently increased the risk for deep vein thrombosis (DVT) (odds ratio, 2.605, P < .001), even after implementing DVT prophylaxis (odds ratio, 2.807, P < .001).…”

“…16 All of the analyses advocated eliminating the routine use of indwelling urinary catheterization, though several found no significant adverse reactions with the use of intermittent catheterization. [1][2][3][5][6][7][8][9][10][11][12][13]16 Most of the studies contended that the act of catheterization itself puts patients at risk for POUR, CAUTI, and urethral injury. 6,8,9,11,13,14 The studies cited involved 49,703 patients.…”