Self-Reported Urological Hospitalizations or Emergency Room Visits in a Contemporary Spinal Cord Injury Cohort

Adoption of Single-Use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort

“…20 Our current study suggests that the dogma of single-use CIC catheters being superior to CIC catheter reuse may be incorrect. Specifically, we find that hospitalizations for genitourinary reasons (for which UTIs make up almost 90% of the cause in SCI populations) 8 did not decrease after the Medicare policy change in 2008, even after controlling for bladder management strategy, age, injury level, injury completeness, and propensity to be hospitalized for nongenitourinary reasons. We similarly show that hospitalizations for genitourinary reasons did not decrease in the subgroup of patients who exclusively performed CIC as their only bladder management method in their first year after rehabilitation discharge.…”

“…However, UTI is one of the most common reasons for SCI readmission overall (∼90% in other studies) and the percentage of genitourinary admissions for non-UTI causes would be expected to stay stable over time. 8,9,12 Another limitation of our study is the potential opportunity for database miscoding of a UTI either as an unknown reason for hospitalization or as an infectious disease category as a reason for hospitalization, though trained data collectors are part of the NSCID and the rate of missing information for hospitalization holds constant throughout the 20+ years of study (6.7% over the study). It may also be suggested that some insurance carriers may have lagged behind Medicare in approving single-use CIC; however, our data suggest that UTI rates even 10 years after the policy change have not occurred (a time when all insurances now cover single-use CIC).…”

“…5,6 Among those requiring catheterization after SCI, UTIs are common, and their effect on bladder-specific quality of life is cited as a bother of primary concern. 7,8 This bother is illustrated by studies in the SCI population demonstrating an ∼40% annual hospitalization rate with UTI and sepsis accounting for over a third of the documented etiologies. 9…”

“…5,6 Among those requiring catheterization after SCI, UTIs are common, and their effect on bladder-specific quality of life is cited as a bother of primary concern. 7,8 This bother is illustrated by studies in the SCI population demonstrating an w40% annual hospitalization rate with UTI and sepsis accounting for over a third of the documented etiologies. 9 While adoption of the single-use CIC policy in the United States theoretically increased the costs of providing catheters to patients roughly 50-fold (from 4 catheters per month to 200 catheters per month), the transition to a new sterilized catheter for each catheterization was intended to be offset by decreasing UTI incidence and more importantly hospitalizations secondary to UTIs (which comprise a large proportion of annual medical costs after SCI).…”

Evaluating the Efficacy of the Centers for Medicare and Medicaid Services Intermittent Catheter Policy Requires a Multifaceted Approach. Letter.

“…Inappropriate selection may introduce an array of unnecessary catheter-associated health problems for the patient, such as bladder and urethral trauma. 2 Additionally, this study does not account for any variances in intermittent catheter user habits that may also increase the risk for UTI, including voiding frequency, fluid intake, hygiene practices, education, and nonintended use of the product, including offlabel reuse of catheters intended for single use. 3,4 The type of payer source is not specified in this study; therefore, it should not be assumed that all individuals followed in this study have had the same access to single-use catheters.…”