Same-surgeon vs separate-surgeon prophylactic ureteral catheterization in colectomy and proctectomy: a national retrospective cohort study.

BACKGROUND

Prophylactic ureteral catheterization (PUC) facilitates ureteral identification during colorectal surgery, but little is known about the outcomes when catheterization is performed by the index colorectal surgeon rather than by a separate surgeon.

METHODS

We performed a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program targeted colectomy and proctectomy data between 2012 and 2024. Adult patients undergoing colectomy and proctectomy with PUC were classified according to whether PUC was performed by the index surgeon (IS-PUC) or by a separate surgeon (SS-PUC). Temporal trends, patient and operative characteristics, postoperative outcomes, and operative time were compared using unadjusted analyzes and multivariable regression models.

RESULTS

Among 24,072 cases, catheterization was performed by the index surgeon in 1365 cases (5.7%) and by a separate surgeon in 22,707 cases (94.3%). IS-PUC remained uncommon, with no significant linear increase over time, and was more frequent in robotic operations, colectomy, nonelective cases, women, and older patients. After adjustment, IS-PUC was not associated with higher odds of overall complication, serious complication, urinary tract infection, ureteral injury, or mortality. IS-PUC was associated with a shorter operative time (β, -10.47 min; 95% CI, -16.58 to -4.36; P <.001).

CONCLUSION

IS-PUC remained uncommon nationally and was associated with shorter operative time, whereas no statistically significant differences in adjusted 30-day outcomes were observed compared with SS-PUC. These findings provide hypothesis-generating data regarding IS-PUC in selected settings and warrant prospective evaluation of case selection, workflow, training, and credentialing.