Timing of Catheter Removal and Effect on Urinary Retention After Cesarean Birth.

Objective: To determine the association between timing of indwelling catheter removal and urinary retention after cesarean.

Design: Retrospective cohort study.

Setting: Eight hospitals in suburban, rural, and urban Colorado and Montana.

Participants: Women who gave birth by cesarean from January 1, 2021 to April 30, 2022 (N = 3,493).

Methods: We categorized participants who gave birth between January 1, 2021 and June 30, 2021 (before implementation of the Enhanced Recovery After Surgery initiative) into Group A and participants who gave birth between July 1, 2021 and April 30, 2022 (after implementation of the Enhanced Recovery After Surgery initiative) into Group B. We used descriptive statistics to report the proportion of participants in both groups who experienced urinary retention after birth. We performed chi-square tests to determine the association between the time of catheter removal and incidence of urinary retention. We used the Wilcoxon rank sum test to determine the association between length of stay and urinary retention.

Results: Urinary retention rates were 5.8% in Group A and 12.6% in Group B (p < .001). In both groups, participants who received epidural anesthesia experienced significantly more urinary retention than those who received spinal anesthesia (p < .001). Participants who received epidural anesthesia and experienced urinary retention pushed 16.9% longer than those without urinary retention (p < .001). The proportion of participants who experienced urinary retention after catheter removal was 19.4% at 7 hours, 4.6% at 16 hours, and 9.9% at 12 hours after birth. Length of stay was determined to be inconclusive.

Conclusion: We determined that the optimal time of catheter removal to minimize the rate of urinary retention was 12 to 16 hours after cesarean among women who received morphine sulfate as the anesthesia.