Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty

Abstract

Background and purpose Postoperative urinary retention (POUR) is a clinical challenge, but there is no scientific evidence for treatment principles. We describe the incidence of and predictive factors for POUR in fast-track total hip (THA) and knee arthroplasty (TKA).Patients and methods This was a prospective observational study involving 1,062 elective fast-track THAs or TKAs, which were performed in 4 orthopedics departments between April and November 2013. Primary outcome was the incidence of POUR, defined by postoperative catheterization. Age, sex, anesthetic technique, type of arthroplasty, and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients.Results The incidence of POUR was 40% (range between departments: 30–55%). Median bladder volume evacuated by catheterization was 0.6 (0.1–1.9) L. Spinal anesthesia increased the risk of POUR (OR = 1.5, 95% CI: 1.02–2.3; p = 0.04) whereas age, sex, and type of arthroplasty did not. Median IPSS was 6 in non-catheterized males and 8 in catheterized males (p = 0.02), but it was 6 in the females in both groups (p = 0.4).Interpretation The incidence of POUR in fast-track THA and TKA was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future.

Analgesic consumption trajectories in 8975 patients 1 year after fast‐track total hip or knee arthroplasty

“…A recent prospective cohort study in THA also demonstrated continued unspecified analgesic use in 32% of patients, as well as a median pain level of 4/10 6 months after surgery (von Dincklage et al., ). However, their patients all had general total intravenous anaesthesia, whereas the use of neuraxial anaesthesia has been reported in about 90% of procedures in the departments contributing to our cohort (Bjerregaard et al., ).…”

Fast track in hip arthroplasty

“…Post-operative urinary retention was found in 40% of THA and TKA patients by Bjerregaard et al, 36 especially in males with pre-operative voiding problems, and patients with spinal analgesia had increased risk. Intermittent catheterisation should be used instead of permanent catheterisation with a safety limit of 800 cc before catheterisation.…”

Clinical and epidemiological profile of patients undergoing total hip arthroplasty

“…According to Bjerregaard et al, [19] the incidence of post-arthroplasty urinary retention was 40%, and their risk was increased when using spinal anesthesia, without relevant influence with age, gender and type of arthroplasty. The application of spinal anesthesia is a risk factor for urinary retention, increasing the postoperative catheterization by about 50% when compared to general anesthesia [19].…”

“…According to Bjerregaard et al, [19] the incidence of post-arthroplasty urinary retention was 40%, and their risk was increased when using spinal anesthesia, without relevant influence with age, gender and type of arthroplasty. The application of spinal anesthesia is a risk factor for urinary retention, increasing the postoperative catheterization by about 50% when compared to general anesthesia [19]. On the other hand, Griesdale et al, [20] in their cohort study on urinary retention after hip and knee arthroplasty, demonstrated the incidence of 43.3% of urinary retention in the first 24 hours postoperatively, assuming that being men that underwent hip arthroplasty and used morphine as associated risk factors; The risk of urinary retention among men was 60.4%, compared with 28.5% among women; And, compared to general anesthesia, men who perform spinal anesthesia with morphine have a 7.1 up to 12.2 times greater chance of urinary retention [20].…”