Effect of urinary catheter removal at different times after caesarean section: A systematic review and network meta-analysis

To assess the optimal time for removal of a urinary catheter (UC) following caesarean section (CS).Several electronic databases were searched from inception to 31 December 2021 regarding the timing of UC removal following CS. The effect of UC removal at different times following CS was calculated using odds ratio (OR) or standardized mean difference and 95% confidence interval (CI). The surface under the cumulative ranking curve (SUCRA) was used to determine the best time for UC removal. All analyses were performed using Stata Version 14.0.In total, 19 studies including 3086 women were included in this review. Compared with UC removal 0-6 h after CS, UC removal 6.1-12 h, 12.1-24 h and > 24 h after CS were more likely to result in urinary tract infection (UTI), with pooled OR of 5.95 (95 % CI 1.58-22.38), 11.26 (95 % CI 2.99-42.44) and 27.25 (95 % CI 6.82-108.90), respectively. UC removal > 24 h after CS was more favourable to prevent urinary retention than immediate UC removal (OR 0.05, 95 % CI 0.00-0.64). UC removal 0-6 h after CS was the optimal timing to prevent UTI and frequent urination, and reduce length of hospital stay as well as time to first ambulation, with maximum SUCRA values of 92.30 %, 85.00 %, 80.60 % and 72.60 %, respectively.UC removal 0-6 h after CS may be the optimal timing to prevent several complications in the absence of a clear indication for UC removal after CS. This study may provide a scientific basis for the timing of UC removal after CS.