Predictors of delayed urinary catheter removal following enhanced recovery after cesarean delivery: a retrospective cohort study
Sunti Barahi, Aswini Kuberan, Xiang Ye, Ronald B George, Naveed Siddiqui

Background and Hypothesis:

Background

ERAC recommends catheter removal within 6–12 hours

Early removal improves mobilization and reduces CAUTI risk

At our center, 30–40% leave PACU with catheter in situ

Objective

Identify clinical and process-of-care predictors of delayed removal

Delay = >360 min or recatheterization

 

Study Design and Methods

Design

Retrospective cohort (12 months), n = 337

Population

Age 18–49, all cesarean urgencies

Excluded: conditions requiring prolonged catheterization

Data Collected

Anesthesia type

PACU motor block (Bromage score)

Intraoperative fluids

Surgical duration

Timing & location of catheter removal

Analysis

Multivariable logistic regression

 

Results

Primary Outcome

44.8% (151/337) had delayed catheter removal

Not Associated

Age, BMI, gestational age, cesarean urgency

Independent Predictors

Denser PACU motor block

Ward vs PACU removal

Higher intraoperative fluids

Delayed motor assessment

Delayed motor recovery

Key Findings

PACU removal ↓ delay: OR 0.13 (0.05–0.33)

+1200 mL fluids → OR 3.12 (1.53–6.35)

Partial motor recovery ↓ odds vs complete block

 

Conclusion and Discussion

Conclusion

Delayed catheter removal remains common (~45%) despite ERAC

Key Drivers

Modifiable perioperative and workflow factors

Not patient demographics

Clinical Implications

Standardize PACU-based removal

Use Bromage-guided timing

Improve fluid stewardship

Prioritize early motor assessment

Take-Home Message

Improving workflow and motor recovery can enhance ERAC adherence and
patient safety