The Most Significant Risk Factors for Urinary Retention in Fast-track Total Joint Arthroplasty are Iatrogenic

Halawi, Mohamad J.; Caminiti, Nicholas; Cote, Mark P.; Lindsay, Adam; Williams, Vincent

doi:10.1016/j.arth.2018.08.042

Cited by 45 publications

(36 citation statements)

References 18 publications

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“…In support of this, the authors of a recent meta-analysis [4] found that the duration of catheterization may influence POUR and stated that a duration of 24-48 hours in those with risk factors for POUR is a reasonable option to reduce its occurrence. Furthermore, the anesthetic type and use of continuous epidural analgesia did not influence POUR, which is similar to prior results [14], but overall controversial [12,15]. Bladder hypotonia is expected to resolve within 8 hours after discontinuation of spinal anesthesia [5], so it is not surprising that no difference in observed urinary retention was observed in our study, which had a minimum of 13.9 hours of urinary catheterization.…”

Section: Discussionsupporting

confidence: 86%

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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Section: Discussionsupporting

confidence: 86%

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

et al. 2020

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“…Routine use of urinary catheterization in fast-track THA may increase the risk of postoperative urinary retention and infection, which are potential sources of infection [24]. These ndings con ict against the routine use of perioperative indwelling catheterization [25,26]. However, our results imply that catheterization is a risk factor and con rm the strong association between catheterization and LOS.…”

Section: Discussionmentioning

confidence: 51%

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

Zeng¹,

Li²,

Yu³

et al. 2020

Preprint

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Background Total hip arthroplasty (THA) is a successful treatment in the improvement of quality of life. Diagnosis-related groups (DRGs) payment has a significant impact on the hospital market in China and length of stay (LOS) is one of its crucial manifestations. Patient characteristics and medical provider factors can affect LOS but the relationship is uncertain. We intent to explore the relationship between patient characteristics and medical provider factors and LOS of primary THA patients. Methods We reviewed the database containing 461 patients who underwent primary THA between January 2014 to January 2019 and regressed the LOS against a variety of perioperative factors. A multivariable linear regression model was performed to assess the difference. Results For parts of patient characteristics, multivariable linear regression analysis revealed that comorbidities, pre-operation albumin < 30 g/L, and pre-operation CRP ≥ 5 mg/L were all significantly associated with LOS (p < 0.05). For parts of medical provider factors, multivariable linear regression analysis revealed that date of surgery, urinary catheter, and incision drainage were all significantly associated with LOS (p < 0.05). Conclusions Patient characteristics and medical provider factors are associated with LOS of THA patients. Evaluation and identification of risk factors are beneficial in patients' education, perioperative discussion and surgery decisions in the different primary THA patient populations.

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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%

“…POUR might differ according to the type of arthroplasty-primary arthroplasty versus revision. Among the 15 studies which were included in this review, 13 studies [10][11][12][13][14][15][16][17][18][19][20][21]23 enrolled patients undergoing primary arthroplasty. The remaining two studies 2,22 seemed to include revision arthroplasties and primary arthroplasties.…”

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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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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The Most Significant Risk Factors for Urinary Retention in Fast-track Total Joint Arthroplasty are Iatrogenic

Cited by 45 publications

References 18 publications

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

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

Patient Characteristics and Medical Provider Factors Are Associated With Length of Stay in Total Hip Arthroplasty Patients: a Retrospective Chinese Cohort Study

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

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