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Omitting Foley Catheter Use in Mastectomy Patients Undergoing Immediate Implant Based Breast Reconstruction
Siu-Yuan Huang, MD 1, Borna Mohabbatizadeh, MD 1, Anna Leung, MD 1, Antoine L Carre, MD, MPH 2 1: Kaiser Permanente Los Angeles Medical Center, Department of General Surgery 2: Kaiser Permanente Los Angeles Medical Center and West Los Angeles Medical Center, Department of Plastic Surgery

Background: Surgeries anticipated to take over 3 hours are generally accompanied by Foley catheter placement to better assess the fluid status of the patient as well as prevent post operative urinary retention. However, this time cutoff is somewhat arbitrary and does not take into account the type of surgery (abdominal, soft tissue, pelvic, orthopedic, etc.). Foley catheter placement is not without risk, and is associated with bacteruria, genitourinary injury, and decreased patient mobility if the catheter stays in after surgery. The purpose of this study is to determine if mastectomy with reconstruction, a procedure generally over 3 hours in length can be done without Foley use without increase in urinary retention risk.

Methods: A total of 87 patients who underwent unilateral or bilateral mastectomies at our institution from January 1st 2020 to December 31st 2020 were reviewed retrospectively. After excluding patients who had a Foley catheter intraoperatively or had in and out catheterization at the conclusion of the case, patients whose surgeries were under 180 minutes long, and patients who did not undergo reconstruction, 24 patients remained. Data was collected from the patient charts, including but not limited to: intraoperative fluids given, estimated blood loss, duration of procedure (from induction to extubation), type of reconstruction, body mass index, age, and patient history of diabetes or hypertension. Charts were searched for documentation of urinary retention and requirement for in and out catheterization or Foley placement post operatively.

Results: Of the 24 patients who underwent unilateral or bilateral mastectomies with reconstruction without intraoperative placement of a Foley catheter whose cases lasted more than 3 hours, none of them experienced post-operative urinary retention, therefore no postoperative in and out catheterization or Foley catheter placement was required. In terms of patient demographics, all patients were female, the average age was 52, and average BMI was 27. 12.5% were diagnosed with hypertension and 8.3% were diabetic. 21 of the cases were unilateral and 3 were bilateral. The average case length was 269 minutes, the average intraoperative fluids given was 977 ml, and average estimated blood loss was 59 ml. 62.5% of the patients underwent two stage breast reconstruction with the first stage being immediate reconstruction with tissue expander and 37.5% underwent direct to implant reconstruction. Out of the 87 patients initially reviewed, 34 did not have reconstruction and 29 had Foley catheters placed. 3 cases with reconstruction and no Foley were excluded as they were under 180 minutes.

Conclusion: Unilateral and bilateral mastectomies with reconstruction that are anticipated to last over 3 hours can be safely done without intraoperative placement of a Foley catheter without increased risk of urinary retention. This also has the potential to spare patients potential Foley catheter-associated complications such as infection or genitourinary tract trauma, the risks of which are small but not negligible. The elimination of Foley use will also have benefits for hospitals in terms of catheter-related complication costs. We plan to expand this study with a prospective component in the future.

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