J. Sobrino1, J. Axt1, J. Sujka1, L. Wedel1, D. Millspaugh1, S. St.Peter1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Pediatric Surgery,Kansas City, MO, USA
Introduction: In some institutions Foley catheters (FC) have been placed in all patients receiving opioid patient-controlled analgesia (PCA) because of the increased incidence of urinary retention. Our institutional data demonstrated no FC replacements in 48 children who had PCA for perforated appendicitis who had their catheters removed before discontinuation of the PCA. As part of a quality improvement initiative we discontinued the practice of requiring FC each time a PCA was used for perforated appendicitis.
Methods: A prospective list of patients with perforated appendicitis was maintained. Data were gathered regarding 65 consecutive patients.
Results:Twenty five percent (16) received a FC with 14 of these being placed in the operating room for physician preference. No patients required replacement of the catheter once removed. Two FCs were placed outside of the OR for urinary retention. In addition mean post-operative length of stay was 119 hours in those with FC and 98 in those without (p 0.06). Mean time on PCA was 80 hours in those with FC and 64 in those without (P 0.02).
Conclusion:FC can be withheld from patients with perforated appendicitis who are placed on PCA with a very low replacement rate. In addition there is a strong trend toward shorter hospital stay and a statistically significant shorter time on PCA for those who do not receive a FC.
