Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty
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...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344120301758 |
| _version_ | 1818187724309397504 |
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| author | Joshua A. Shapiro, MD Paul M. Alvarez, MD Anthony V. Paterno, MS Christopher W. Olcott, MD Daniel J. Del Gaizo, MD |
| author_facet | Joshua A. Shapiro, MD Paul M. Alvarez, MD Anthony V. Paterno, MS Christopher W. Olcott, MD Daniel J. Del Gaizo, MD |
| author_sort | Joshua A. Shapiro, MD |
| collection | DOAJ |
| description | 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 (+0.22 mg/dL) but was preserved in others (+0.02-0.04 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. Level of Evidence: Retrospective Analysis, Level IV. |
| first_indexed | 2024-12-11T23:15:35Z |
| format | Article |
| id | doaj.art-c020279e0a224a62827aa650315c97a7 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-11T23:15:35Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-c020279e0a224a62827aa650315c97a72022-12-22T00:46:32ZengElsevierArthroplasty Today2352-34412020-12-0164888893Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee ArthroplastyJoshua A. Shapiro, MD0Paul M. Alvarez, MD1Anthony V. Paterno, MS2Christopher W. Olcott, MD3Daniel J. Del Gaizo, MD4Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USASchool of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Corresponding author. 376 West 10th Avenue, 725 Prior Hall, Columbus, OH 43210-1228, USA. Tel.: +1 786 253 3491.School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USADepartment of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USADepartment of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USABackground: 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 (+0.22 mg/dL) but was preserved in others (+0.02-0.04 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. Level of Evidence: Retrospective Analysis, Level IV.http://www.sciencedirect.com/science/article/pii/S2352344120301758Total hip arthroplastyTotal knee arthroplastyUrinary catheterizationPostoperative urinary retentionBladder outlet obstructionRenal function |
| spellingShingle | Joshua A. Shapiro, MD Paul M. Alvarez, MD Anthony V. Paterno, MS Christopher W. Olcott, MD Daniel J. Del Gaizo, MD Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty Arthroplasty Today Total hip arthroplasty Total knee arthroplasty Urinary catheterization Postoperative urinary retention Bladder outlet obstruction Renal function |
| title | Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty |
| title_full | Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty |
| title_fullStr | Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty |
| title_full_unstemmed | Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty |
| title_short | Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty |
| title_sort | analysis of risks and consequences of postcatheter urinary retention after primary total hip and knee arthroplasty |
| topic | Total hip arthroplasty Total knee arthroplasty Urinary catheterization Postoperative urinary retention Bladder outlet obstruction Renal function |
| url | http://www.sciencedirect.com/science/article/pii/S2352344120301758 |
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