A Novel Tubeless Urinary Catheter Protocol Enhanced Recovery After Minimally Invasive Lung Surgery

Abstract

Objectives: Although previous studies have shown the feasibility of non-intubated techniques, it is unknown whether avoiding urinary catheters can enhance recovery. This study aimed to determine whether the tubeless urinary catheter protocol is feasible and beneficial for minimally invasive lung surgery. Methods: Patients were randomized to the control group, completely tubeless group, and partially tubeless group. A propensity score–matched (PSM) analysis was performed to balance the non-random baseline characteristics. Complications and postoperative recovery were compared. Regression analysis was performed to identify the independent predictors of complications. A nomogram for predicting the risk of non-automatic micturition was constructed and internally validated. Results: One hundred fifty-nine patients were enrolled. The incidence rates of urinary irritation and urinary tract infection (UTI) were significantly lower in the tubeless groups (74.4 vs. 39.5%, p < 0.001; 28.2 vs. 8.6%, p = 0.001, respectively). The tubeless group had a higher proportion of 0-degree discomfort (81.5 vs. 30.8%, p = 0.001) and shorter duration of postoperative hospital stay than the control group (4.59 vs. 5.53 days, p < 0.001). No difference was observed in terms of urination retention and urinary incontinence between the tubeless group and the control group. After PSM, the advantages of the tubeless group still existed, and comparing to the partially tubeless group, the completely tubeless group was of even less UTI and more 0-degree discomfort (18.5 vs. 0.0%, p = 0.019; 96.3 vs. 59.3%, p = 0.002). The tubeless protocol was the only independent protective factor of urinary complications. A nomogram was constructed and showed good predictive ability. Conclusions: The tubeless catheterization protocol led to fewer complications, better compliance, and shorter hospital length of stay. The advantages were more significant with the completely tubeless protocol. The utility of our nomogram can assist clinicians in avoiding risks in performing the tubeless protocol.

The short-term outcomes for the early removal of pigtail catheter drainage within 24 hours of uniportal video-assisted anatomic surgery in patients with lung cancer

“…The presence of urinary catheters limits the development of day surgery. A previous study showed that in the case of normal renal function, when the operation time is not long, it is not necessary to insert a urinary catheter ( 16 ). The presence of chest tubes for draining gas and liquid has become an obstacle to thoracic day surgery.…”

The feasibility and advantages of immediate removal of urinary catheter after lobectomy: A prospective randomized trial

“…SCIP 9, one of the adopted requirements, mandates the removal of urinary catheters within 48 hr after surgery to reduce the risk of CAUTI (Centers for Medicare & Medicaid Services, 2017). Enhanced recovery after surgery (ERAS) is also recommended by the guidelines in cardiac and pulmonary surgery (Engelman et al., 2019) and immediate removal of the urinary catheter after surgery has shown advantages in clinical practice (Van Backer et al., 2019; Meillat et al., 2021; Okrainec et al., 2017; Wang et al., 2020). In perioperative management of lung cancer removal surgery, the advantages may include the reduction in adverse urethra irritation, risk of urinary tract infections, use of antibiotics and enhancement of early postoperative movement, which may facilitate rapid postoperative recovery and shorten the length of hospital stay.. Injecting warm normal saline into the bladder before removing the catheter has been shown to be an effective method to urge patients to urinate spontaneously after extubation (Chao and Mansuria, 2019; Mills et al., 2020; Wormer et al., 2017).…”