EP603 - Can Colorectal Catheterize? Evaluating the Colorectal Surgeon's Role in Prophylactic Ureteral Catheterization for Colorectal Surgery

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Purpose/Background: Prophylactic ureteral catheterization (PUC) is often performed in colorectal surgery to aid in identification and protection of the ureter. Because this falls outside of general and colorectal surgery training, PUC typically requires coordination with a urologist or urogynecologist, with associated challenges in scheduling, availability, and OR efficiency. We hypothesized that colorectal surgeons (CRS) are performing PUC independently at increased rates resulting in shorter operative times. In this study, we aimed to define national trends and outcomes for PUC as performed by the CRS.

Methods/Interventions: This was a retrospective study of the American College of Surgeons National Quality Improvement Program Database (ACS-NSQIP), from 2012 through 2022, using the available targeted data for colectomy and proctectomy cases. PUC was defined as any patient who had the CPT code for ureteral catheterization listed as a simultaneous procedure at the time of colorectal surgery. This group was further divided into two cohorts: (1) PUC was done by the same surgeon who performed the index colorectal operation (CRS) and (2) PUC was done by a different surgeon. Based on common practice, the latter was presumed to be either a urologist or urogynecologist. The surgeon performing the index colorectal operation is referred to in this study as a CRS. Annual trends were analyzed using Cochran-Armitage chi-square testing. Continuous and categorical variables were compared using Student’s t-test and chi-square respectively, with statistical significance set as P< 0.05.

Results/Outcomes: A total of 258,257 patients were included, with an overall PUC rate of 5.0% (N=12,943). Of these PUCs, 12,242 (94.6%) were performed by urologists, and 701 (5.4%) were performed by the CRS. Over the timeframe of the study, there was a significant increase in rate of CRS performing PUC independently (1.98-6.84%; p< 0.001) and a related decrease in urologists performing this procedure (98.0-93.2%; p< 0.001)(Figure 1). CRS and urology cohorts had comparable mean age (59.0±14.4 vs. 58.0±14.4, p=0.06), and had similar sex distribution (45.2 vs. 46.7% male; p=0.44). The cohort of patients who had PUC done by CRS included higher rates of emergency operation (6.1% vs. 2.2%; p< 0.001), lower rates of rectal surgery (14.7 vs. 17.7%; p< 0.001), and shorter mean operative time (265 vs. 279 minutes; p< 0.01) in comparison to the group whose PUC was performed by a urologist. In terms of outcomes, there were no differences in mortality (0.57 vs. 0.78%; p=0.66) or overall morbidity (18.8 vs. 18.2%, p=0.62) between the cohorts. There was a lower rate of ureteral injury in the CRS group, though rates were low in both cohorts (0.57 vs. 0.88%; p< 0.001).

Conclusion/Discussion: Though the vast majority of PUC are still performed by urologists, the frequency of CRS performing PUC independently has more than tripled in the last decade. This study highlights some advantageous features of this practice pattern, including increased PUC access in emergency settings and reductions in operative time, which may be related to more efficient OR workflow. Adverse outcomes with CRS-independent PUC compared to urologists were not observed. Colorectal training programs should strongly consider incorporating PUC into the standard education offered to future colorectal surgeons.