The Relationship of Indwelling Urinary Catheters to Death, Length of Hospital Stay, Functional Decline, and Nursing Home Admission in Hospitalized Older Medical Patients

doi:10.1111/j.1532-5415.2007.01064.x

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Wiley InterScience

Journal of the American Geriatrics Society

Volume 55 Issue 2, Pages 227 - 233

Published Online: 18 Jan 2007

Journal compilation 2010 The American Geriatrics Society/Wiley Periodicals, Inc.

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The Relationship of Indwelling Urinary Catheters to Death, Length of Hospital Stay, Functional Decline, and Nursing Home Admission in Hospitalized Older Medical Patients

Jayna M. Holroyd-Leduc, MD ^*† , Saunak Sen, PhD ^† , Dan Bertenthal, MS ^† , Laura P. Sands, PhD ^‡ , Robert M. Palmer, MD, MPH ^§ , Denise M. Kresevic, PhD ^∥¶ , Kenneth E. Covinsky, MD, MPH ^† , and C. Seth Landefeld, MD ^†

From the ^*Department of Medicine, University of Calgary, Canada; ^†Division of Geriatrics, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, California; ^‡School of Nursing and Center for Aging and the Life Course, Purdue University, West Lafayette, Indiana; ^§Section of Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio; ^∥Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and ^¶Department of Medical-Surgical Nursing University Hospitals of Cleveland, Cleveland, Ohio

Address correspondence to Jayna M. Holroyd-Leduc, Foothills Medical Center, Room 707, 7th Floor North Tower, 1403–29th Street NW, Calgary, Alberta, Canada T2N 2T9. E-mail: jayna.holroyd-leduc@calgaryhealthregion.ca

KEYWORDS

urinary catheters • hospitalized older patients • mortality • morbidity

ABSTRACT

OBJECTIVES: To determine the association between indwelling urinary catheterization without a specific medical indication and adverse outcomes.

DESIGN: Prospective cohort.

SETTING: General medical inpatient services at a teaching hospital.

PARTICIPANTS: Five hundred thirty-five patients aged 70 and older admitted without a specific medical indication for urinary catheterization.

INTERVENTION: Indwelling urinary catheterization within 48 hours of admission.

MEASUREMENTS: Death, length of hospital stay, decline in ability to perform activities of daily living (ADLs), and new admission to a nursing home.

RESULTS: Indwelling urinary catheters were placed in 76 of the 535 (14%) patients without a specific medical indication. Catheterized patients were more likely to die in the hospital (6.6% vs 1.5% of those not catheterized, P=.006) and within 90 days of hospital discharge (25% vs 10.5%, P<.001); the greater risk of death with catheterization persisted in a propensity-matched analysis (hazard ratio (HR)=2.42, 95% confidence interval (CI)=1.04–5.65). Catheterized patients also had longer lengths of hospital stay (median, 6 days vs 4 days; P=.001); this association persisted in a propensity-matched analysis (HR=1.46, 95% CI=1.03–2.08). Catheterization was not associated (P>.05) with decline in ADL function or with admission to a nursing home.

CONCLUSION: In this cohort of older patients, urinary catheterization without a specific medical indication was associated with greater risk of death and longer hospital stay.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1532-5415.2007.01064.x About DOI