Incidence of Postoperative Urinary Tract Infection in Fragility Hip Fracture after Preoperative Urinary Catheter: A Randomized Controlled Trial

Abstract

Purpose: Urinary tract infection (UTI) is a prevalent complication following fragility hip fractures in the elderly, significantly impacting morbidity and mortality. Whether preoperative urinary catheterization mitigates or exacerbates this risk remains a subject of clinical debate. This study evaluates the impact of preoperative urinary catheterization on the incidence of postoperative UTI in patients aged 60 years and older undergoing surgery for fragility hip fractures.

Methods: In this prospective randomized controlled trial, 114 elderly patients were randomized (1:1) into either a preoperative urinary catheter (PUC) group or non-urinary catheter (NUC) group at a single tertiary center. The primary outcome was the incidence of symptomatic UTI (SUTI). Secondary outcomes included asymptomatic bacteremic UTI (ABUTI), acute urinary retention (AUR), postoperative pneumonia, and length of hospital stay (LOS).

Results: Among the 114 patients analyzed, the incidence of SUTI was higher in the PUC group than in the NUC group; however, this did not reach statistical significance. Similarly, the rate of ABUTI was identical in both groups. The NUC group exhibited a higher incidence of AUR (19.30% vs. 8.77%); however, the difference was not statistically significant. Notably, the PUC group experienced a significantly higher rate of postoperative pneumonia and prolonged mean LOS.

Conclusions: Routine preoperative urinary catheterization in elderly patients with fragility hip fractures was associated with a higher clinical trend of symptomatic UTIs, significantly increased rates of postoperative pneumonia, and prolonged hospital stays. The findings show that avoiding routine catheterization may help mitigate systemic complications and facilitate recovery.