S. Mohammed1, Y. R. Yu1,2, R. Sola3, J. T. Lackey1, S. John4, E. Rosenfeld1,2, W. Zhang2, S. D. St. Peter3, S. R. Shah1,2 1Baylor College Of Medicine,Division Of General Surgery,Houston, TX, USA 2Texas Children’s Hospital,Division Of Pediatric Surgery,Houston, TX, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Division Of Pediatric Surgery,Kansas City, MO, USA 4University Of Texas Health Science Center At Houston,Houston, TX, USA
Introduction: Patient-controlled analgesia (PCA) is often used for postoperative pain control in children with perforated appendicitis. Additionally, some providers routinely use postoperative Foley catheters in this population to prevent urinary retention; however, this practice varies by surgeon and institution. The objective of this study was to determine the rate of urinary retention in this patient population to guide future practice.
Methods: A retrospective review was performed of all pediatric patients (≤ 18 years old) who received PCA postoperatively for perforated appendicitis between July 2015 and June 2016 at two academic children’s hospitals. Data collected included patient characteristics, intraoperative findings, postoperative narcotic use, and incidence of urinary retention and urinary tract infections. Urinary retention was defined as the inability to spontaneously void during the postoperative period requiring straight catheterization or placement of a Foley catheter. Statistical analysis was performed using the Wilcoxon rank test and Fisher’s exact test, as appropriate. Additional univariate logistic regression analysis was performed to identify risk factors for urinary retention.
Results: A total of 313 patients (mean age 9.5 ± 3.9 years) underwent appendectomy for perforated appendicitis during the study period (175 at Hospital 1 and 138 at Hospital 2). An intraoperative Foley catheter was placed in 22 (13%) patients at Hospital 1, and 107 (78%) patients at Hospital 2 (p<0.0001). For the combined study population there were 196 (63%) males and the overall postoperative length of stay was 5.6 ± 2.9 days. The mean PCA morphine usage was 0.4 ± 0.3 mg/kg/day per patient. Age, gender, and body mass index (BMI) was similar between those that had an intraoperative Foley catheter placed (n=129) and those that did not (n=184). There were no urinary tract infections in either group. The urinary retention rate was 4.3% (n=8) for patients without an intraoperative Foley catheter, and 0.8% (n=1) for those with an intraoperative Foley catheter after removal on the inpatient unit (p=0.06). Univariate analysis of patient characteristics, intraoperative findings, PCA specifics (narcotic type, duration, average daily usage, and basal rate), postoperative length of stay, and postoperative abscess formation did not identify any significant risk factors for urinary retention.
Conclusion: Practice variations exist regarding placement of intraoperative Foley catheters in children with perforated appendicitis. However, the risk of urinary retention in this population is low despite the use of patient-controlled analgesia. Based on these results we conclude that children with perforated appendicitis do not require routine postoperative Foley catheter placement to prevent urinary retention.