Newly Published
Perioperative Medicine  |   February 2018
Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis
Author Notes
  • From the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine (H.B., I.B., T.V., A.R.), and the Institute for Medical Biometry, Epidemiology and Medical Informatics (S.W.), Saarland University, University Medical Center, Homburg/Saar, Germany; the Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital, Frankfurt, Germany (P.K.); the Department of Anesthesiology and Intensive Care Therapy, Philipps University Marburg, Germany (H.W.); the Department of Anesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Germany (T.S.); the Department of Anesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hannover, Germany (A.G.); the Department of Anesthesiology and Intensive Care Medicine, Hospital Calw-Nagold, Germany (J.D.); the Department of Anesthesiology, St. Marien-Hospital, Siegen, Germany (W.H.); the Department of Anesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Germany (J.B., C.S.); the Department of Anesthesiology, Intensive Care and Pain Therapy, University and Rehabilitation Clinics, Ulm, Germany (B.K., J.W.); the Department of Anesthesiology, Intensive Care and Pain Therapy, HELIOS Hospital Erfurt, Germany (S.L.-B.); the Department of Anesthesiology and Intensive Care, Jena University Hospital, Germany (W.M.); the Department of Anesthesiology, Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany (O.V., T.K.); and the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio (D.I.S.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication May 2, 2017. Accepted for publication December 27, 2017.
    Submitted for publication May 2, 2017. Accepted for publication December 27, 2017.×
  • Acknowledgments: German Network for Regional Anesthesia investigators are all participating hospital centers that collected data about catheter duration and grade of infection for the current study: Berlin—Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Germany, Claudia Spies, M.D.; Berlin—German Red Cross Hospital Westend, Berlin, Germany, Arnd Timmermann, M.D.; Bochum—Ruhr-University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Germany, Michael Adamzik, M.D.; Bad Saarow—HELIOS Hospital Bad Saarow, Germany, Stefan Wirtz, M.D.; Dresden—University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany, Thea Koch, M.D.; Erfurt—HELIOS Hospital Erfurt, Germany, Andreas Meier-Hellmann, M.D., and Simone Liebl-Biereige, M.D.; Frankfurt—Orthopedic University Hospital, Frankfurt, Germany, Paul Kessler, M.D.; Frankfurt—Berufsgenossenschaftliche Casualty Hospital, Frankfurt, Germany, Rolf Teßmann, M.D.; Hamburg—University Medical Centre Hamburg-Eppendorf, Germany, Alwin E. Goetz, M.D.; Hannover—Friederikenstift Hannover, Germany, André Gottschalk, M.D.; Jena—University Hospital, Jena, Germany, Winfried Meissner, M.D.; Lengerich—HELIOS Hospital Lengerich, Germany, Albrecht Pfeiff, M.D.; Ludwigsburg—Hospital Ludwigsburg, Germany, Götz Geldner, M.D.; Marburg—Philipps University Marburg, Germany, Hinnerk F. W. Wulf, M.D.; Memmingen—Hospital, Memmingen, Germany, Lars Fischer, M.D.; Siegen—St. Marien-Hospital, Siegen, Germany, Werner Hering, M.D.; Solingen—Academic Hospital Solingen, Germany, Thomas Standl, M.D.
    Acknowledgments: German Network for Regional Anesthesia investigators are all participating hospital centers that collected data about catheter duration and grade of infection for the current study: Berlin—Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Germany, Claudia Spies, M.D.; Berlin—German Red Cross Hospital Westend, Berlin, Germany, Arnd Timmermann, M.D.; Bochum—Ruhr-University Bochum, University Hospital Knappschaftskrankenhaus Bochum, Germany, Michael Adamzik, M.D.; Bad Saarow—HELIOS Hospital Bad Saarow, Germany, Stefan Wirtz, M.D.; Dresden—University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany, Thea Koch, M.D.; Erfurt—HELIOS Hospital Erfurt, Germany, Andreas Meier-Hellmann, M.D., and Simone Liebl-Biereige, M.D.; Frankfurt—Orthopedic University Hospital, Frankfurt, Germany, Paul Kessler, M.D.; Frankfurt—Berufsgenossenschaftliche Casualty Hospital, Frankfurt, Germany, Rolf Teßmann, M.D.; Hamburg—University Medical Centre Hamburg-Eppendorf, Germany, Alwin E. Goetz, M.D.; Hannover—Friederikenstift Hannover, Germany, André Gottschalk, M.D.; Jena—University Hospital, Jena, Germany, Winfried Meissner, M.D.; Lengerich—HELIOS Hospital Lengerich, Germany, Albrecht Pfeiff, M.D.; Ludwigsburg—Hospital Ludwigsburg, Germany, Götz Geldner, M.D.; Marburg—Philipps University Marburg, Germany, Hinnerk F. W. Wulf, M.D.; Memmingen—Hospital, Memmingen, Germany, Lars Fischer, M.D.; Siegen—St. Marien-Hospital, Siegen, Germany, Werner Hering, M.D.; Solingen—Academic Hospital Solingen, Germany, Thomas Standl, M.D.×
  • Research Support: This analysis was supported by institutional funds. The German Network for Regional Anesthesia was supported by the German Society of Anesthesiology and Intensive Care Medicine (Nuremberg, Germany), the Association of German Anesthesiologists (Nuremberg, Germany), and the German Research Foundation (Bonn, Germany).
    Research Support: This analysis was supported by institutional funds. The German Network for Regional Anesthesia was supported by the German Society of Anesthesiology and Intensive Care Medicine (Nuremberg, Germany), the Association of German Anesthesiologists (Nuremberg, Germany), and the German Research Foundation (Bonn, Germany).×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Bomberg: Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Kirrbergerstrasse 1, 66421 Homburg/Saar, Germany. Hagen.Bomberg@uks.eu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Infectious Disease / Regional Anesthesia / Technology / Equipment / Monitoring
Perioperative Medicine   |   February 2018
Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis
Anesthesiology Newly Published on February 7, 2018. doi:10.1097/ALN.0000000000002105
Anesthesiology Newly Published on February 7, 2018. doi:10.1097/ALN.0000000000002105
Abstract

Background: Prolonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days.

Methods: Our analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use.

Results: After adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections.

Conclusions: Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.