Comparison of Early vs Routine Urinary Catheter Removal in Postoperative Cesarean Section Patients: A Prospective Outcome Analysis

Introduction: Even though cesarean section (CS) is one of the most common surgeries performed worldwide, still there is no uniformity in the postoperative management protocols.Enhanced recovery after surgery (ERAS) society guidelines suggest removal of the catheter immediately after cesarean or within 6 hours.However, adherence to this protocol is still not very high, and most Obstetrics and Gynecology (OBG) units continue catheterization till the next morning after surgery.Hence, in this study, we tried to assess the duration of postoperative catheterization in our hospital and to evaluate the differences in outcomes among patients with early and delayed catheter removal in our hospital.Aims: 1.To know the pattern of postoperative urinary catheterization duration in our hospital.2. To evaluate the differences in outcomes among patients with early and delayed catheter removal.Methods with statistics: We recruited a total of 158 patients who underwent CS in the months of June and July 2024 at the Government Medical College Manjeri and followed them up till discharge.Patients requiring a longer duration of catheterization, like those with a bladder injury or eclampsia, were excluded.At our hospital, one OBG unit practices ERAS protocol, and other units practice conventional care.These patients were divided into 2 groups based on the timing of catheter removal [urinary catheter removed at 6 hours (early catheter removal) and removed >6 hours (routine care)].These groups were prospectively observed for the presence of irritative urinary symptoms, time for ambulation (hours), first void time after catheter removal, duration of hospital stay, urinary retention, re-catheterization, and incidence of surgical site infection (SSI).Data were analyzed using SPSS version 29.Results: 33 women had early catheter removal while 125 women received routine care [>6 hours-33 (20.9%), 6-12 hours-28 (17.7%), 12-24 hours-93 (58.9%), and >24 hours-4 (2.5%)].Both groups were comparable in age, body mass index (BMI), and gestational age.There was no significant difference in the presence of irritative urinary symptoms, urinary retention, re-catheterization, or the presence of SSIs between the two groups.The time for the first ambulation was 7.83 hours [standard deviation (SD): 0.59] in the early catheter removal group and 16.50 hours (SD: 4.59) in the routine care group (p = 0.000).There was a significant difference in the duration of hospital stay also [3.15 (SD: 1.29) vs 4.13 days (SD: 0.94) (p = 0.000)].There was a significant difference in the first urine void time also, [early catheter removal group: 82.3 minutes (SD: 131.26) and routine care group: 37.44 minutes (SD: 23.47) (p = 0.000)]. Conclusion:Early removal of urinary catheters after CS was associated with early mobilization from the bed, and this may have contributed to reduced hospital stay.Early catheter removal was not associated with an increase in urinary retention and re-catheterization.Our study suggests that early catheter removal should be practiced in all hospitals.Studies with larger sample sizes could be done to find out differences in other aspects like urinary infection and SSI rates.