(Poster 81) Optimal Time for Foley Removal After Cesarean Section

Objectives: The objective of our study was to compare genitourinary complaints and complications after cesarean section, based on time to foley catheter removal, early foley removal ( < 8 hours) compared to late foley removal (> 8 hours).

Methods: A retrospective chart review was conducted of all patients that underwent cesarean section during 2022. Patients were excluded if foley catheter data was not documented, they sustained bladder injury, or there were medical complications requiring foley for greater than one week. Demographic information and delivery information were obtained from the electronic medical record (EMR). 2 groups were compared, based on time to foley catheter removal, early removal( < 8 hours) and late removal (> 8 hours). Our primary outcome was incidence of urinary retention after foley catheter removal. Other outcomes collected, included time to first void, amount of first void, urinary tract infections (UTIs), need for foley catheter replacement, genitourinary complaints during the index admission, as well as 6 week post-operative genitourinary data. Comparisons in patient characteristics across time to post-op Foley removal are assessed via chi-squared or t-test. p < 0.05 was considered statistically significant. Odds of urinary outcomes were estimated via logistic regression. Estimates are reported as odds ratios (ORs).

Results: 352 total patients were included in the study. There was no difference in age, gravidity, parity, race, comorbidities, neonatal birthweight and substance use, among the 2 groups. Patients in the early foley removal group had lower BMIs (kg/m2) (34.4 in the early, compared to 36.7 in the late), delivered at later gestational ages (weeks) (38.3 in the early, compared to 37.5 in the late), p = 0.014.
Patients in the early foley removal group had lower rates of urinary retention 9.3% (10), compared to 3.7% (9) in the late foley removal group, p < 0.05. There were also significantly more urinary complaints during the index admission in the early group (12.1%) compared to 5.3% in the late. Time to first void was longer in the early group (316.4 min compared to 235 minutes in the late group), and volume of first void was significantly less (325.9 mL in early group compared to 403.7 mL in the late group). Early removal of the Foley compared to late removal displayed a reduction in odds of urinary retention (OR: 0.37, p: 0.036) and a reduction in any urinary complaints during admission (OR: 0.41, p: 0.028).

Conclusions: There is a paucity of obstetric data to guide obstetricians in the appropriate time to remove the Foley catheter after cesarean section. Our study suggests decreased risk of urinary retention, as well as any genitourinary complaints with Foley catheter removal greater than 8 hours after surgery.