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European Journal of Orthopaedic Surgery & Traumatology

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01-02-2018 | Original Article • KNEE - ARTHROPLASTY

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

Authors: N. P. Kort, Y. Bemelmans, R. Vos, M. G. M. Schotanus

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 2/2018

Abstract

Purpose

Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after surgery, is a commonly reported complication. This study reports the incidence and possible risk factors for POUR after elective fast-track hip or knee arthroplasty when using a nurse-led bladder scan protocol.

Methods

This retrospective cohort study included data from 803 patients who underwent unilateral hip or knee arthroplasty. Patients’ digital clinical records were reviewed for eligibility. Patients with incomplete data registration, preoperative bladder volume >250 ml, preexisting bladder catheterization, and/or patients following the outpatient pathway were excluded. Bladder volumes were assessed at different moments pre- and postoperatively. The outcome was the incidence of POUR, defined as the inability to void spontaneously with a bladder volume >600 ml, treated with indwelling catheterization. Further analysis between POUR and non-POUR patients was performed to detect possible risk factors for POUR.

Results

Six hundred and thirty-eight patients operated on primary unilateral hip or knee arthroplasty were analyzed. The incidence of POUR was 12.9% (n = 82, 95% CI 9.4–15.5). Gender, age, BMI, ASA classification, preoperative bladder volume, type of anesthesia, type of arthroplasty, and perioperative fluid administration were not significant different between POUR and non-POUR patients. Patients with a bladder volume of >200 ml at the recovery room were at higher risk (OR 5.049, 95% CI 2.815–9.054) for POUR.

Conclusions

When using a nurse-led bladder scan protocol in fast-track hip and knee arthroplasty, the incidence of POUR was 12.9%, with a bladder volume of >200 ml at the recovery room as a risk factor for POUR.

Level of evidence

A retrospective cohort study, Level III.

Balderi T, Carli F (2010) Urinary retention after total hip and knee arthroplasty. Minerva Anestesiol 76(2):120–130PubMed

Balderi T, Mistraletti G, D’Angelo E, Carli F (2011) Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol 77:1050–1057PubMed

Baldini G, Bagry H, Aprikian A, Carli F (2009) Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology 110(5):1139–1157CrossRefPubMed

Bjerregaard LS, Bagi P, Kehlet H (2014) Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop 85(1):8–10CrossRefPubMedPubMedCentral

Bjerregaard LS, Bogo S, Raaschou S, Troldborg C, Hornum U, Poulsen AM, Bagi P, Kehlet H (2015) Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty. Acta Orthop 86(2):183–188CrossRefPubMedPubMedCentral

Bjerregaard LS, Hornum U, Troldborg C, Bogoe S, Bagi P, Kehlet H (2016) Postoperative urinary catheterization thresholds of 500 versus 800 ml after Fast-track total hip and knee arthroplasty: a randomized, open-label, controlled trial. Anesthesiology 124(6):1256–1264CrossRefPubMed

Choi S, Awad I (2013) Maintaining micturition in the perioperative period: strategies to avoid urinary retention. Curr Opin Anaestesiol 26(3):361–367CrossRef

Collard V, Mistraletti G, Taqi A, Asenjo JF, Feldman LS, Fried GM, Carli F (2007) Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg 105:1255–1262CrossRefPubMed

Daurat A, Choquet O, Bringuier S, Charbit J, Egan M, Capdevila X (2015) Diagnosis of postoperative urinary retention using a simplified ultrasound bladder measurement. Anesth Analg 120(5):1033–1038CrossRefPubMed

10.

Fernandez MA, Karthikeyan S, Wyse M, Foguet P (2014) The incidence of postoperative urinary retention in patients undergoing elective hip and knee arthroplasty. Ann R Coll Surg Engl 96(6):462–465CrossRefPubMedPubMedCentral

11.

Griesdale DE, Neufeld J, Dhillon D, Joo J, Sandhu S, Swinton F, Choi PT (2011) Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth 58(12):1097–1104CrossRefPubMedPubMedCentral

12.

Hälleberg-Nyman M, Gustafsson M, Langius-Eklöf A, Johansson JE, Norlin R, Hagberg L (2013) Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis. Int J Nurs Stud 50(12):1589–1598CrossRefPubMed

13.

Huang Z, Ma J, Shen B, Pei F (2015) General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty. J Arthroplasty 30(3):502–506CrossRefPubMed

14.

Hansen BS, Søreide E, Warland AM, Nilsen OB (2011) Risk factors of post-operative urinary retention in hospitalised patients. Acta Anaesthesiol Scand 55(5):545–548PubMed

15.

Hollman F, Wolterbeek N, Veen R (2015) Risk factors for postoperative urinary retention in men undergoing total hip arthroplasty. Orthopedics 38(6):507–511CrossRef

16.

Iorio R, Healy WL, Patch DA, Appleby D (2000) The role of bladder catheterization in total knee arthroplasty. Clin Orthop Relat Res 380:80–84CrossRef

17.

Iorio R, Whang W, Healy WL, Patch DA, Najibi S, Appleby D (2005) The utility of bladder catheterization in total hip arthroplasty. Clin Orthop Relat Res 432:148–152CrossRef

18.

Joelsson-Alm E, Ulfvarson J, Nyman CR, Divander MB, Svensén C (2012) Preoperative ultrasound monitoring can reduce postoperative bladder distension: a randomized study. Scand J Urol Nephrol 46(2):84–90CrossRefPubMed

19.

Kehlet H (2013) Fast-track hip and knee arthroplasty. Lancet 381(9878):1600–1602CrossRefPubMed

20.

Keita H, Diouf E, Tubach F, Brouwer T, Dahmani S, Mantz J, Desmonts JM (2005) Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg 101(2):592–596CrossRefPubMed

21.

Lingaraj K, Ruben M, Chan YH, Das SD (2007) Identification of risk factors for urinary retention following total knee arthroplasty: a Singapore hospital experience. Singapore Med J 48(3):213–216PubMed

22.

Miller AG, McKenzie J, Greenky M, Shaw E, Gandhi K, Hozack WJ, Parvizi J (2013) Spinal anesthesia: should everyone receive a urinary catheter? A randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg (Am) 95(16):1498–1503CrossRef

23.

Pavlin DJ, Pavlin EG, Gunn HC, Taraday JK, Koerschgen ME (1999) Voiding in patients managed with or without ultrasound monitoring of bladder volume after outpatient surgery. Anesth Analg 89(1):90–97PubMed

24.

Schotanus MG, Bemelmans YF, van der Kuy PH, Jansen J, Kort NP (2015) No advantage of adrenaline in the local infiltration analgesia mixture during total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25(9):2778–2783. doi:10.1007/s00167-015-3723-4 CrossRefPubMed

25.

Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91:65–71CrossRef

26.

Sung KH, Lee KM, Chung CY, Kwon SS, Lee SY, Ban YS, Park MS (2015) What are the risk factors associated with urinary retention after orthopaedic surgery? Biomed Res Int 2015:613216PubMedPubMedCentral

27.

Tischler EH, Restrepo C, Oh J, Matthews CN, Chen AF, Parvizi J (2016) Urinary retention is rare after total joint arthroplasty when using opioid-free regional anesthesia. J Arthroplasty 31(2):480–483CrossRefPubMed

28.

Tomaszewski D, Bałkota M, Truszczyński A, Machowicz A (2014) Intrathecal morphine increases the incidence of urinary retention in orthopaedic patients under spinal anaesthesia. Anaesthesiol Intensive Ther 46(1):29–33CrossRefPubMed

29.

Zhang W, Liu A, Hu D, Xue D, Li C, Zhang K, Ma H, Yan S, Pan Z (2015) Indwelling versus intermittent urinary catheterization following total joint arthroplasty: a systematic review and meta-analysis. PLoS ONE 10(7):0130636

Title: 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
Authors: N. P. Kort
Y. Bemelmans
R. Vos
M. G. M. Schotanus
Publication date: 01-02-2018
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 2/2018
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-017-2042-5

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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

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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