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Background Historically, it has been assumed that indwelling urinary catheters used to prevent urinary retention in patients undergoing epidural analgesia should be left in for the duration of the epidural analgesia. Our institution initiated an early Foley removal (EFR) program in thoracic surgical oncology patients to remove indwelling catheter while the epidural analgesia was still in place, 24–72 h after surgery. The objective of this study was to evaluate the feasibility of EFR in terms of rate of re-catheterization, urinary tract infections (UTI), or the length of hospital stay (LOS). Methods We reviewed the medical records of 99 thoracic surgical oncology patients who underwent EFR with indwelling epidural analgesia from May 2012 to February 2013. The main outcome variable was re-catheterization incidence. We also compared a propensity matched subgroup of patients who had undergone surgery prior to the institution of EFR. The outcome variables for this group were the rate of UTI and LOS. Results In the EFR group (N = 99), the median duration of Foley catheterization was 40 h. Sixteen (16%) patients experienced difficulty voiding within 8 h of catheter removal, 8 required re-catheterization (8%). In the propensity-matched analysis, there was no difference in the rate of UTI between the two groups (1% in both groups). Conclusions EFR was associated with a low re-catheterization rate. Our findings support the CDC's recommendation to remove catheters early in thoracic surgical oncology patients. EFR will promote patient comfort and may play an important role in improving the postoperative care in thoracic oncology patients.

To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges.FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after esophagectomy.We retrospectively reviewed 708 consecutive patients who underwent esophagectomy for primary esophageal cancer during the 4 years before (group A; 322 patients) or 4 years after (group B; 386 patients) the institution of an FTEP. Postoperative morbidity and mortality, LOS, and hospital charges were reviewed.Compared with group A, group B had significantly shorter median LOS (12 days vs 8 days; P0.001); lower mean numbers of SICU days (4.5 days vs 1.2 days; P0.001) and telemetry days (12.7 days vs 9.7 days; P0.001); and lower rates of atrial arrhythmia (27% vs 19%; P = 0.013) and pulmonary complications (27% vs 20%; P = 0.016). Multivariable analysis revealed FTEP to be associated with shorter LOS (P0.001) even after adjustment for predictors like tumor histology and location. FTEP was also associated with a lower rate of pulmonary complications (odds ratio = 0.655; 95% confidence interval = 0.456, 0.942; P = 0.022). In addition, the median hospital charges associated with primary admission and readmission within 90 days for group B ($65,649) were lower than that for group A ($79,117; P0.001).These findings suggest that an FTEP reduces patients' LOS, perioperative morbidity, and hospital charges.