Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty: A prospective, observational study

Lars S Bjerregaard; Stina Bogø; Sofie Raaschou; Charlotte Troldborg; Ulla Hornum; Alicia M Poulsen; Per Bagi; Henrik Kehlet

doi:10.3109/17453674.2014.972262

Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty: A prospective, observational study

Lars S Bjerregaard, Stina Bogø, Sofie Raaschou, Charlotte Troldborg, Ulla Hornum, Alicia M Poulsen, Per Bagi, Henrik Kehlet

Department of Clinical Medicine

37 Citations (Scopus)

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.

Original language	English
Journal	Acta Orthopaedica (Print Edition)
Volume	86
Issue number	2
Pages (from-to)	183-8
Number of pages	6
ISSN	1745-3674
DOIs	https://doi.org/10.3109/17453674.2014.972262
Publication status	Published - 1 Apr 2015

Keywords

Adult
Aged
Aged, 80 and over
Anesthesia, Spinal
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Elective Surgical Procedures
Female
Humans
Incidence
Male
Middle Aged
Postoperative Complications
Prospective Studies
Risk Factors
Urinary Catheterization
Urinary Retention
Young Adult

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10.3109/17453674.2014.972262

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title = "Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty: A prospective, observational study",

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.",

keywords = "Adult, Aged, Aged, 80 and over, Anesthesia, Spinal, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Elective Surgical Procedures, Female, Humans, Incidence, Male, Middle Aged, Postoperative Complications, Prospective Studies, Risk Factors, Urinary Catheterization, Urinary Retention, Young Adult",

author = "Bjerregaard, {Lars S} and Stina Bog{\o} and Sofie Raaschou and Charlotte Troldborg and Ulla Hornum and Poulsen, {Alicia M} and Per Bagi and Henrik Kehlet",

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day = "1",

doi = "10.3109/17453674.2014.972262",

language = "English",

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journal = "Acta Orthopaedica",

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TY - JOUR

T1 - Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty

T2 - A prospective, observational study

AU - Bjerregaard, Lars S

AU - Bogø, Stina

AU - Raaschou, Sofie

AU - Troldborg, Charlotte

AU - Hornum, Ulla

AU - Poulsen, Alicia M

AU - Bagi, Per

AU - Kehlet, Henrik

PY - 2015/4/1

Y1 - 2015/4/1

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Anesthesia, Spinal

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Elective Surgical Procedures

KW - Female

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Prospective Studies

KW - Risk Factors

KW - Urinary Catheterization

KW - Urinary Retention

KW - Young Adult

U2 - 10.3109/17453674.2014.972262

DO - 10.3109/17453674.2014.972262

M3 - Journal article

C2 - 25301436

SN - 1745-3674

VL - 86

SP - 183

EP - 188

JO - Acta Orthopaedica

JF - Acta Orthopaedica

IS - 2

ER -

Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty: A prospective, observational study

Abstract

Keywords

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