The Effect of Bladder Catheterization Technique on Postoperative Urinary Tract Infections After Primary Total Hip Arthroplasty

Garbarino, Luke J.; Gold, Peter A.; Anis, Hiba K.; Sodhi, Nipun; Burshtein, Joshua; Burshtein, Aaron; Danoff, Jonathan R.; Boraiah, Sreevathsa; Rasquinha, Vijay J.; Mont, Michael A.

doi:10.1016/j.arth.2020.01.039

Cited by 11 publications

(12 citation statements)

References 17 publications

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“…found indwelling catheterization to be associated with a lower rate of POUR with no effect on the rate of postoperative UTI in a cohort of patients undergoing both THA and total knee arthroplasty [ 14 ]. This is in contrast to Garbarino et al., who identified indwelling urinary catheterization as an independent risk factor for UTI in a retrospective review of over 7300 patients undergoing primary THA [ 15 ]. When considering primary THA performed under spinal anesthesia specifically, a randomized controlled trial of 200 patients by Miller et al.…”

Section: Discussioncontrasting

confidence: 58%

Routine Indwelling Urinary Catheterization Is Not Necessary During Total Hip Arthroplasty Performed Under Spinal Anesthesia

et al. 2022

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Section: Discussioncontrasting

confidence: 58%

Routine Indwelling Urinary Catheterization Is Not Necessary During Total Hip Arthroplasty Performed Under Spinal Anesthesia

et al. 2022

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“…Multiple recent studies have demonstrated a notable association between increasing age and the development of POUR. 4-6,8,17,18 This contrasts with a study by Bracey et al 10 that found no association between age and POUR. Male sex has also been linked to the development of POUR in multiple studies, although one prospective cohort study found no association between the two.…”

Section: Patient Risk Factorsmentioning

confidence: 71%

“…3 In addition, POUR is associated with increased rates of urinary tract infection; 5% to 22% of the patients undergoing catheterization develop a subsequent urinary tract infection, which is accompanied by an increased risk for periprosthetic joint infection. 4,5 Although POUR is not a new phenomenon, the advent of modern rapid recovery TJA with an emphasis on same-day or next-day patient discharge has highlighted the importance of appropriately mitigating its occurrence. The objective of this review was to synthesize the recent literature on POUR in the setting of TJA: discussing incidence, predisposing risk factors, scoring assessments for risk stratification, prevention strategies, and treatment.…”

mentioning

confidence: 99%

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Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

Bracey

Barry

Khanuja

et al. 2022

J Am Acad Orthop Surg

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Postoperative urinary retention (POUR) is a disruptive complication after modern rapid recovery total joint arthroplasty. This review aims to synthesize the recent literature on POUR in the setting of total joint arthroplasty. The incidence of POUR ranges from 5.5% to 46.3%. The lack of a standardized definition of POUR accounts for some of this variability. Risk factors previously associated with the development of POUR include increasing age, male sex, benign prostatic hyperplasia, use of bupivacaine and intrathecal morphine in spinal anesthesia, glycopyrrolate, and volume of intraoperative intravenous fluid administered. Predictive scoring assessments, such as the International Prostate Symptom Score and a newer predictive nomogram, have not been adequately validated by high-quality studies. The treatment of POUR comprises either intermittent or indwelling urethral catheterization. Higher quality prospective studies are needed to allow for the standardization of all aspects of POUR from its diagnostic criteria to its treatment.

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“…However, catheters have also been associated with UTI [21][22][23] . The incidence of catheter-associated UTI increases the longer a catheter remains in place 24 , which is concerning as UTIs have been associated with the development of periprosthetic joint infections (PJIs) [25][26][27] . Therefore, catheter use to mitigate POUR is controversial.…”

mentioning

confidence: 99%

Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA

Weintraub

Yang

Nam

et al. 2022

Journal of Bone and Joint Surgery

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Background: The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).Methods: Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ‡2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ‡450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ‡1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.Results: Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ‡1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis. Conclusions:The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.

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The Effect of Bladder Catheterization Technique on Postoperative Urinary Tract Infections After Primary Total Hip Arthroplasty

Cited by 11 publications

References 17 publications

Routine Indwelling Urinary Catheterization Is Not Necessary During Total Hip Arthroplasty Performed Under Spinal Anesthesia

Routine Indwelling Urinary Catheterization Is Not Necessary During Total Hip Arthroplasty Performed Under Spinal Anesthesia

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty

Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA

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