RESEARCH PAPER
Association between duration of urinary catheterization and post-operative mobilization following elective
cesarean section: A retrospective case-control study in Espoo, Finland
More details
Hide details
1
University of Eastern Finland,
Kuopio, Finland
2
Department of Obstetrics and
Gynecology, Helsinki University
Hospital, University of Helsinki,
Helsinki, Finland
Submission date: 2024-05-16
Final revision date: 2024-09-21
Acceptance date: 2024-09-23
Publication date: 2024-11-07
Corresponding author
Marja Kaijomaa
Department
of Obstetrics and Gynecology,
Helsinki University Hospital,
University of Helsinki,
Haartmaninkatu 2, 00290
Helsinki, Finland
Eur J Midwifery 2024;8(November):66
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Cesarean section is the most common surgery performed on women.
The enhanced recovery recommendations are early urinary catheter removal and early
mobilization, as essential elements of post-operative care. This study aimed to analyze
the association between these elements and whether limiting the catheter treatment
duration affects the timing of post-operative mobilization.
Methods:
This retrospective case-control study compared the mobilization of healthy
elective cesarean patients under different instructions on urinary catheter removal: cases
with a preset catheter removal time (8–12 hours) and controls with catheter removal
based on midwife considerations. Apart from the preset time of catheter removal, the
routine post-operative care was given by the same personnel without any advice on
patient mobilization. Data on patient demographics, surgery details, post-operative
medication, first upright mobilization, the length of hospital stay, and patient satisfaction
were analyzed.
Results:
The study comprised 52 cases and one control for each case (N=104). The mean
duration of urinary catheterization was 20.15 ± 6.59 and 11.30 ± 4.20 hours in the control
and intervention groups, respectively (p<0.001). A linear regression analysis showed a
significant association between the catheter removal time and patient mobilization, when
adjusted for maternal background parameters (age, BMI, fear of childbirth diagnosis, prior
uterine scar), duration and timing of the surgery, bleeding and post-operative analgesic
use (R2=0.444, p<0.001). No difference was detected in the length of hospital stay, or
patient satisfaction.
Conclusions:
Limiting the duration of urinary catheter therapy is associated with shorter
time to post-operative mobilization. A prospective randomized trial would provide more
detailed information.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE
form for Disclosure of Potential Conflicts of Interest. The
authors declare that they have no competing interests, financial
or otherwise, related to the current work. A. Väänänen reports
receiving support for the present work from the University
of Helsinki Central Hospital, Women’s Hospital, Department
of Obstetrics and Anesthesiology (permitted the study and
facilitated access to the patient records). She also reports
receiving funding for the article processing charges that will be
covered from the University of Helsinki Library. Furthermore, she
reports receiving facilitated leave of absence from clinical work
to complete this study from the Finnish Medical Foundation
(personal grant).
FUNDING
There was no source of funding for this research.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Helsinki University
Research Council (Approval number: HUS/730/2022). Based on
national legislation (Medical Research Act 488/1999), the need
for written informed consent was waived for this retrospective
study.
DATA AVAILABILITY
The data supporting this research are available from the authors
on reasonable request.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
REFERENCES (35)
1.
Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. doi:10.1136/bmjgh-2021-005671
2.
Ghoreishi J. Indwelling urinary catheters in cesarean delivery. Int J Gynaecol Obstet. 2003;83(3):267-270. doi:10.1016/s0020-7292(03)00144-9
3.
Pandey D, Mehta S, Grover A, Goel N. Indwelling Catheterization in Caesarean Section: Time To Retire It! J Clin Diagn Res. 2015;9(9):QC01-QC4. doi:10.7860/JCDR/2015/13495.6415
4.
Varadhan KK, Lobo DN, Ljungqvist O. Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin. 2010;26(3):527-x. doi:10.1016/j.ccc.2010.04.003
5.
Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630-641. doi:10.1016/s0002-9610(02)00866-8
6.
Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol. 2019;221(3):247.e1-247.e9. doi:10.1016/j.ajog.2019.04.012
7.
Wilson RD, Caughey AB, Wood SL, et al. Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am J Obstet Gynecol. 2018;219(6):523.e1-523.e15. doi:10.1016/j.ajog.2018.09.015
8.
Caughey AB, Wood SL, Macones GA, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol. 2018;219(6):533-544. doi:10.1016/j.ajog.2018.08.006
9.
Meng X, Chen K, Yang C, Li H, Wang X. The Clinical Efficacy and Safety of Enhanced Recovery After Surgery for Cesarean Section: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies. Front Med (Lausanne). 2021;8:694385. doi:10.3389/fmed.2021.694385
10.
Patel K, Zakowski M. Enhanced Recovery After Cesarean: Current and Emerging Trends. Curr Anesthesiol Rep. 2021;11(2):136-144. doi:10.1007/s40140-021-00442-9
11.
Perinatal statistics - parturients, delivers and newborns 2022: One in five deliveries resulted in a caesarean section. Official Statistics of Finland; 2023. Updated June 13, 2024. Accessed September 21, 2024.
https://www.julkari.fi/bitstre...
12.
Liang CC, Chang SD, Chang YL, Chen SH, Chueh HY, Cheng PJ. Postpartum urinary retention after cesarean delivery. Int J Gynaecol Obstet. 2007;99(3):229-232. doi:10.1016/j.ijgo.2007.05.037
13.
Murphy C, Prieto J, Fader M. "It's easier to stick a tube in": a qualitative study to understand clinicians' individual decisions to place urinary catheters in acute medical care. BMJ Qual Saf. 2015;24(7):444-450. doi:10.1136/bmjqs-2015-004114
14.
Krein SL, Kowalski CP, Harrod M, Forman J, Saint S. Barriers to reducing urinary catheter use: a qualitative assessment of a statewide initiative. JAMA Intern Med. 2013;173(10):881-886. doi:10.1001/jamainternmed.2013.105
15.
Fontela PC, Forgiarini LA Jr, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Atitudes clínicas e barreiras percebidas para a mobilização precoce de pacientes graves em unidades de terapia intensiva adulto. Rev Bras Ter Intensiva. 2018;30(2):187-194. doi:10.5935/0103-507X.20180037
16.
Brown CJ, Williams BR, Woodby LL, Davis LL, Allman RM. Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians. J Hosp Med. 2007;2(5):305-313. doi:10.1002/jhm.209
17.
Jain M, Dogra V, Mishra B, Thakur A, Loomba PS. Knowledge and attitude of doctors and nurses regarding indication for catheterization and prevention of catheter-associated urinary tract infection in a tertiary care hospital. Indian J Crit Care Med. 2015;19(2):76-81. doi:10.4103/0972-5229.151014
18.
Niederhauser A, Züllig S, Marschall J, Schwappach DL; progress! Safe Urinary Catheterization Collaboration Group. Nurses' and Physicians' Perceptions of Indwelling Urinary Catheter Practices and Culture in Their Institutions. J Patient Saf. 2020;16(2):e82-e89. doi:10.1097/PTS.0000000000000502
19.
Twomey R, Matthews TW, Nakoneshny S, et al. Impact of Early Mobilization on Recovery after Major Head and Neck Surgery with Free Flap Reconstruction. Cancers (Basel). 2021;13(12):2852. doi:10.3390/cancers13122852
20.
Tazreean R, Nelson G, Twomey R. Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements. J Comp Eff Res. 2022;11(2):121-129. doi:10.2217/cer-2021–0258
21.
Yang G, Bao X, Peng J, et al. Repeated Cesarean Delivery Predicted a Higher Risk of Inadequate Analgesia Than Primary Cesarean Delivery: A Retrospective Study with Propensity Score Match Analysis. J Pain Res. 2020;13:555-563. doi:10.2147/JPR.S229566
22.
Duan G, Yang G, Peng J, et al. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol. 2019;19:189. doi:10.1186/s12871-019-0865-9
23.
Safdar N, Codispoti N, Purvis S, Knobloch MJ. Patient perspectives on indwelling urinary catheter use in the hospital. Am J Infect Control. 2016;44(3):e23-e24. doi:10.1016/j.ajic.2015.10.011
24.
Elvy J, Colville A. Catheter associated urinary tract infection: what is it, what causes it and how can we prevent it? J Infect Prev. 2009;10(2):36-41. doi:10.1177/1757177408094852
25.
Abdel-Aleem H, Aboelnasr MF, Jayousi TM, Habib FA. Indwelling bladder catheterisation as part of intraoperative and postoperative care for caesarean section. Cochrane Database Syst Rev. 2014;2014(4):CD010322. doi:10.1002/14651858.CD010322.pub2
26.
Mitobe Y, Yoshioka T, Baba Y, et al. Predictors of Catheter-Related Bladder Discomfort After Surgery: A Literature Review. J Clin Med Res. 2023;15(4):208-215. doi:10.14740/jocmr4873
27.
Hou D, Jia Y, Han A, Hu Q, Li J, Liang W. Effect of urinary catheter removal at different times after caesarean section: A systematic review and network meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;280:160-167. doi:10.1016/j.ejogrb.2022.12.002
28.
Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L. Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial. Obstet Gynecol. 2013;121(3):533-537. doi:10.1097/AOG.0b013e318280d50a
29.
Talec P, Gaujoux S, Samama CM. Early ambulation and prevention of post-operative thrombo-embolic risk. J Visc Surg. 2016;153(6)(suppl):S11-S14. doi:10.1016/j.jviscsurg.2016.09.002
30.
Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJ. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6(4):632-637. doi:10.1111/j.1538-7836.2008.02921.x
31.
Jackson E, Curtis KM, Gaffield ME. Risk of venous thromboembolism during the postpartum period: a systematic review. Obstet Gynecol. 2011;117(3):691-703. doi:10.1097/AOG.0b013e31820ce2db
32.
Blondon M, Casini A, Hoppe KK, Boehlen F, Righini M, Smith NL. Risks of Venous Thromboembolism After Cesarean Sections: A Meta-Analysis. Chest. 2016;150(3):572-596. doi:10.1016/j.chest.2016.05.021
33.
Idawati I, Khaironnisa D, Aisyah S, Husna N, Setiawati D. Effect of early mobilization on post SC pain (a literature review). Science Midwifery. 2023;11(3):620-628. doi:10.35335/midwifery.v11i3.1260
34.
Ulfa Y, Maruyama N, Igarashi Y, Horiuchi S. Women's experiences of breastfeeding after a cesarean section: A meta-synthesis. Jpn J Nurs Sci. 2023;20(3):e12534. doi:10.1111/jjns.12534
35.
Laronche A, Popescu L, Benhamou D. An enhanced recovery programme after caesarean delivery increases maternal satisfaction and improves maternal-neonatal bonding: A case control study. Eur J Obstet Gynecol Reprod Biol. 2017;210:212-216. doi:10.1016/j.ejogrb.2016.12.034