Injury. 2026 Jun 13;57(8):113449. doi: 10.1016/j.injury.2026.113449. Online ahead of print.
ABSTRACT
INTRODUCTION: Urinary tract infection(UTI) is a common complication following hip fracture surgery in elderly patients. Urinary catheterization is frequently used to improve patient comfort during prolonged preoperative immobilization; however, its impact on UTI risk and renal function remains controversial. This prospective randomized study aimed to evaluate the effect of urinary catheter use on postoperative UTI incidence and renal outcomes in geriatric patients undergoing hip fracture surgery.
MATERIALS AND METHODS: This prospective randomized controlled trial included 150 patients aged > 65 years who underwent surgical treatment for proximal femur fractures between December 2022 and May 2025. Patients with UTI at admission, prior indwelling catheter use, high-energy trauma, multiple fractures, or a history of pelvic radiation were excluded. Patients were randomized into two groups: catheterized(n = 75) and non-catheterized(n = 75). Urinary tract infection was defined according to European Association of Urology (EAU) guideline criteria. Renal function was assessed using serum urea and creatinine levels measured preoperatively and on postoperative day 1. Demographic data, comorbidities, fluid intake, and perioperative variables were recorded and compared between groups.
RESULTS: The mean patient age was 79.8±7.2 years, and 61.3% were female. Postoperative UTI occurred in 20 patients (15.2%) overall. UTI was detected in 12 patients (18.5%) in the catheterized group and in 8 patients (11.9%) in the non-catheterized group, with no statistically significant difference between the groups (p = 0.296). Female sex and advanced age were identified as significant risk factors for UTI development. Postoperative creatinine levels were significantly higher in the non-catheterized group (p < 0.01), which was also associated with lower preoperative oral fluid intake. No significant association was found between UTI development and diabetes mellitus, hypertension, or coronary artery disease.
CONCLUSIONS: Indwelling urinary catheterization did not significantly increase postoperative UTI risk in elderly patients undergoing hip fracture surgery. Moreover, catheter use may help prevent dehydration-related renal dysfunction by facilitating adequate oral fluid intake. Careful, short-term catheterization may therefore represent a reasonable strategy in selected geriatric hip fracture patients.
PMID:42296627 | DOI:10.1016/j.injury.2026.113449
