Laird Harrison

May 13, 2013

SAN DIEGO, California — Hospital admissions from indwelling catheters are mushrooming, costing lives and money, a new study shows.

"There are more and more complications," Janet Colli, MD, associate professor of urology at the University of Tennessee in Memphis, told Medscape Medical News.

Dr. Colli presented results from a study of hospitalizations here at the American Urological Association 2013 Annual Scientific Meeting.

To quantify the complications from catheters, Dr. Colli and her team analyzed data from the National Inpatient Sample Healthcare Cost and Utilization Project.

This national dataset comes from a stratified sampling of 20% of nonfederal hospitals in the United States. The researchers identified hospitalizations listing complications from indwelling urinary catheters as the principal diagnosis for admission.

They also identified secondary procedures and diagnoses associated with the hospital stay, and examined the length of stay, in-hospital deaths, and aggregate charges.

From 2001 to 2010, hospitalizations for this diagnosis nearly quadrupled, costing $1.3 billion for catheter-related hospitalizations alone. When secondary diseases associated with the hospital stay were added in, the cost reached $10.5 billion.

Septicemia rates in these patients increased as well, and caused death in 891 people in 2010, the researchers report.

In addition to infections, fluid and electrolyte disorders and essential hypertension can result from urinary catheters.

Table. Complications From Indwelling Urinary Catheters

Year 2001 2010
Hospitalizations, n 11,742 40,429
Septicemia, n 2,475 16,279
In-hospital deaths, n 346 891
Primary cost of hospitalizations $175 million $1.3 billion

 

What's behind this growing problem?

"Patients are living longer, surviving their strokes, so they need more catheters," said Dr. Colli.

Infections can result from poor cleaning or from leaving the catheter in place too long. "Bacteria ascends stagnant urine in the catheter," Dr. Colli explained.

Most of the infections are in people 65 to 84 years of age.

The problem is greater in men because men are more likely to suffer from urinary retention, said Tomas Griebling, MD, urology professor at the University of Kansas in Kansas City, who was asked by Medscape Medical News to comment on the findings.

He added that physicians and nursing staff use catheters more often than they should. "If you have a complex medical patient and you want to measure or collect their urine, the easiest thing is to put in a catheter," said Dr. Griebling, who was not involved with the study. "It's a convenience."

In addition, nursing staff often find it easier to catheterize immobilized patients than to help them urinate through hand-held urinals or bedside commodes, he said.

But Dr. Colli and Dr. Griebling agree that providing staff for these tasks upfront could save a big toll on the healthcare system.

Dr. Colli offered this advice for physicians: "Assess the placement of the catheter very thoroughly. Decide if the patient really needs it and how long they need it, because there are big risks. If the patients can urinate on their own, it's probably better. If they do need a catheter, meticulous care should be provided."

Data on catheters with antibiotic or silver coating are mixed, said Dr. Griebling. Some studies have even indicated that washing catheters too frequently can cause harm, he added.

For incontinent women, diapers might be a good alternative. In other cases, staff can insert catheters for urination, then remove them afterward, said Dr. Colli. "It's more time-consuming for the nursing staff, but there is less risk of infection."

Dr. Griebling noted that pressure is mounting for physicians to take better care of catheters. For example, the Centers for Medicare and Medicaid Services (CMS) will no longer give additional payments to hospitals to treat these infections.

"When CMS says they're not going to pay for this," he said, "that's a huge incentive to do something about it."

Dr. Griebling and Dr. Colli have disclosed no relevant financial relationships.

American Urological Association (AUA) 2013 Annual Scientific Meeting. Abstract 58. Presented May 5, 2013.

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