Low incidence of postoperative urinary retention with the use of a nurse-led bladder scan protocol after hip and knee arthroplasty: a retrospective cohort study

Kort, Nanne P.; Bemelmans, Yoeri F. L.; Vos, Reinder; Schotanus, Martijn G.M.

doi:10.1007/s00590-017-2042-5

Cited by 32 publications

(28 citation statements)

References 27 publications

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“…The main features and results of the 15 studies are presented in Table 1. 2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] Diagnostic criteria and incidence of POUR In all of the 15 studies, the diagnosis of POUR was made by ultrasound. Each study adopted various volume criteria from 350 mL to 700 mL for the diagnosis of POUR.…”

Section: Search Resultsmentioning

confidence: 99%

“…Recent studies reported that monitoring with the use of an ultrasound scan decreases the incidence of POUR and recommended the ultrasound scan at 6–8 h after the start of anesthesia. 15,19,25 In all studies, POUR patients were treated with intermittent catheterization. In case of inevitable use of an indwelling catheter, it should be removed within 48 h, because the duration of catheterization is closely related with the development of UTI.…”

Section: Discussionmentioning

confidence: 99%

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Urinary retention after total joint arthroplasty of hip and knee: Systematic review

Han

Lee

Won

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Postoperative urinary retention (POUR) is a common complication after total joint arthroplasties (TJAs). The POUR is managed with urinary catheterization, which is associated with a risk of urinary tract infection and subsequent periprosthetic joint infection. The purpose of this review was to afford a comprehensive understanding of POUR and its management. Methods: We identified 15 original articles concerning POUR after TJA, which were published from January 2010 to February 2019. The diagnostic method, incidence, risk factors, and management of POUR of the 15 studies were reviewed. Results: The incidence of POUR was ranged from 4.1% to 46.3%. Ultrasound was used for the detection of POUR among the total of the 15 studies. The following factors of old age, male gender, benign prostatic hypertrophy, history of urinary retention, spinal/epidural anesthesia, excessive fluid administration, patient-controlled analgesia, the use of opiates, underlying comorbidities, and poor American Society of Anesthesiologists (ASA) grade were risk factors for POUR. Most of the studies did not use indwelling catheterization during surgery. The POUR patients were managed with intermittent catheterization. The most common volume criterion for bladder catheterization was 400 mL. In inevitable use of an indwelling catheter, it should be removed within 48 h. Conclusions: This review provided an up-to-date guide for the detection and management of POUR. Level of Evidence: Level III.

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Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urinary retention after total joint arthroplasty of hip and knee: Systematic review

Han

Lee

Won

et al. 2020

J Orthop Surg (Hong Kong)

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“…For patients, increased adherence to guidelines for voiding care in the orthopaedic context can decrease the risk of adverse events and complications associated with hip surgery [ 52 ], particularly the often preventable risk of urinary retention [ 53 ]. Further, advanced interprofessional teamwork to address urinary retention is likely to incorporate the patient perspective, enhancing opportunities for individuals to participate in issues regarding their health and healthcare [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION—a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers’ implementation strategy

et al. 2021

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Background The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. Methods Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. Discussion The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. Trial registration The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.

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“…With the development of fast-track protocols after TJAs, it is imperative that POUR can be quickly identified and managed to reduce the development of subsequent complications. Previous studies have used routine postoperative bladder scans, stating that bladder volumes of greater than 200 mL significantly increases the risk of developing POUR [9]. On review of the literature, the risk factors associated with the development of POUR after prophylactic indwelling catheterization have been sparingly defined and their consequential effect on renal function has been understudied.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

et al. 2020

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Background: Postoperative urinary retention (POUR) in total joint arthroplasty (TJA) is common. However, risk factors for POUR and its consequences, specifically on postoperative renal function, have not been well defined. Methods: We performed a review of prospectively collected data on consecutive adult patients undergoing primary total joint arthroplasty from August 2014 to December 2015. Catheters were placed preoperatively and removed on the first or second postoperative day. The exclusion criterion was traumatic catheter insertion or the presence of fracture or neoplasm. Univariate and multiple logistic regression identified associations with POUR and its invasive therapies. Subgroup analysis of renal function by incidence of preoperative bladder outlet obstruction (BOO) and POUR was performed with nonparametric testing. Results: A total of 591 operations met inclusion criteria. The incidence of POUR was 6.4% and was directly related to a positive history of BOO (odds ratio [OR]: 4.15) and increased the duration of urinary catheterization (OR: 1.04). These factors, in addition to preoperative incontinence (OR: 8.36, 28.69) and lengthier hospitalizations (OR: 1.37, 1.30), were significantly associated with intermittent straight catheterization and reinsertion of an indwelling catheter to treat POUR. Serum creatinine increased with combined preoperative BOO and POUR (þ0.22 mg/dL) but was preserved in others (þ0.02-0.04 mg/dL) (P < 0.01). Conclusions: Preoperative BOO and longer catheterization increased the risk of POUR and were associated with the use of invasive modalities to treat POUR. POUR was associated with a longer hospitalization and impaired renal function in those with preoperative BOO; therefore, renal function should be monitored closely and nephrotoxic medications used cautiously when using urinary catheters in this patient population.

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Low incidence of postoperative urinary retention with the use of a nurse-led bladder scan protocol after hip and knee arthroplasty: a retrospective cohort study

Abstract: A retrospective cohort study, Level III.

Cited by 32 publications

References 27 publications

Urinary retention after total joint arthroplasty of hip and knee: Systematic review

Urinary retention after total joint arthroplasty of hip and knee: Systematic review

Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION—a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers’ implementation strategy

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

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