The Relationship of Indwelling Urinary Catheters to Death, Length of Hospital Stay, Functional Decline, and Nursing Home Admission in Hospitalized Older Medical Patients

Abstract

To determine the association between indwelling urinary catheterization without a specific medical indication and adverse outcomes. Prospective cohort. General medical inpatient services at a teaching hospital. Five hundred thirty-five patients aged 70 and older admitted without a specific medical indication for urinary catheterization. Indwelling urinary catheterization within 48 hours of admission. Death, length of hospital stay, decline in ability to perform activities of daily living (ADLs), and new admission to a nursing home. Indwelling urinary catheters were placed in 76 of the 535 (14%) patients without a specific medical indication. Catheterized patients were more likely to die in the hospital (6.6% vs 1.5% of those not catheterized, P=.006) and within 90 days of hospital discharge (25% vs 10.5%, P<.001); the greater risk of death with catheterization persisted in a propensity-matched analysis (hazard ratio (HR)=2.42, 95% confidence interval (CI)=1.04-5.65). Catheterized patients also had longer lengths of hospital stay (median, 6 days vs 4 days; P=.001); this association persisted in a propensity-matched analysis (HR=1.46, 95% CI=1.03-2.08). Catheterization was not associated (P>.05) with decline in ADL function or with admission to a nursing home. In this cohort of older patients, urinary catheterization without a specific medical indication was associated with greater risk of death and longer hospital stay.