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Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty.

Abstract

BACKGROUND

Postoperative urinary retention (POUR) following total joint arthroplasty (TJA) presents a significant barrier to outpatient and early discharge TJA. This study examined the incidence and risk factors for acute POUR in a modern, evidence-based, outpatient, and early discharge TJA program.

METHODS

Prospectively recorded data on 685 consecutive primary unilateral TJAs discharged the day of or day after surgery were retrospectively reviewed. POUR was diagnosed by a perioperative internal medicine specialist. Univariate analysis of potential predictors was performed, followed by binary logistic regression (BLR) testing of predictors with P ≤ .25.

RESULTS

After exclusions for confounds, the final analysis sample consisted of 633 procedures. The overall incidence of POUR was 5.5% (3.9% for same day discharges). Male gender, history of urinary retention, use of rocuronium, use of glycopryrrolate, use of neostigmine, fentanyl spinals, and the absence of an indwelling urethral catheter were associated with acute POUR and met criteria for entry into multivariate BLR. Seventeen additional predictors, including kidney disease and outpatient surgery were unrelated to POUR. In the final BLR model (P = .001), male patients who received glycopyrrolate with neostigmine had a 34% probability of developing POUR, which declined to 2.8% in the absence of these risk factors.

CONCLUSION

Despite a relatively low incidence of 5.5%, avoidance of anticholinergics and cholinesterase inhibitors during anesthesia should be carefully considered in outpatient TJA, particularly in stand-alone ambulatory surgery centers.

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  • Authors+Show Affiliations

    ,

    Department of Orthopedics, Indiana University Health Orthopedics, Fishers, IN.

    ,

    Anesthesia Consultants of Indiana LLC, Indianapolis, IN.

    ,

    Indiana University School of Medicine, Indianapolis, IN.

    ,

    Indiana University School of Medicine, Indianapolis, IN.

    ,

    Indiana University School of Medicine, Indianapolis, IN.

    Department of Orthopedics, Indiana University Health Orthopedics, Fishers, IN; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.

    Source

    The Journal of arthroplasty 34:7S 2019 Jul pg S343-S347

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30956046

    Citation

    Ziemba-Davis, Mary, et al. "Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty." The Journal of Arthroplasty, vol. 34, no. 7S, 2019, pp. S343-S347.
    Ziemba-Davis M, Nielson M, Kraus K, et al. Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty. J Arthroplasty. 2019;34(7S):S343-S347.
    Ziemba-Davis, M., Nielson, M., Kraus, K., Duncan, N., Nayyar, N., & Meneghini, R. M. (2019). Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty. The Journal of Arthroplasty, 34(7S), pp. S343-S347. doi:10.1016/j.arth.2019.03.015.
    Ziemba-Davis M, et al. Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty. J Arthroplasty. 2019;34(7S):S343-S347. PubMed PMID: 30956046.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty. AU - Ziemba-Davis,Mary, AU - Nielson,Mark, AU - Kraus,Kent, AU - Duncan,Nathan, AU - Nayyar,Nimra, AU - Meneghini,R Michael, Y1 - 2019/03/12/ PY - 2018/12/03/received PY - 2019/03/03/revised PY - 2019/03/05/accepted PY - 2019/4/9/pubmed PY - 2019/4/9/medline PY - 2019/4/9/entrez KW - early discharge KW - hip KW - knee KW - outpatient KW - total joint KW - urinary retention SP - S343 EP - S347 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 34 IS - 7S N2 - BACKGROUND: Postoperative urinary retention (POUR) following total joint arthroplasty (TJA) presents a significant barrier to outpatient and early discharge TJA. This study examined the incidence and risk factors for acute POUR in a modern, evidence-based, outpatient, and early discharge TJA program. METHODS: Prospectively recorded data on 685 consecutive primary unilateral TJAs discharged the day of or day after surgery were retrospectively reviewed. POUR was diagnosed by a perioperative internal medicine specialist. Univariate analysis of potential predictors was performed, followed by binary logistic regression (BLR) testing of predictors with P ≤ .25. RESULTS: After exclusions for confounds, the final analysis sample consisted of 633 procedures. The overall incidence of POUR was 5.5% (3.9% for same day discharges). Male gender, history of urinary retention, use of rocuronium, use of glycopryrrolate, use of neostigmine, fentanyl spinals, and the absence of an indwelling urethral catheter were associated with acute POUR and met criteria for entry into multivariate BLR. Seventeen additional predictors, including kidney disease and outpatient surgery were unrelated to POUR. In the final BLR model (P = .001), male patients who received glycopyrrolate with neostigmine had a 34% probability of developing POUR, which declined to 2.8% in the absence of these risk factors. CONCLUSION: Despite a relatively low incidence of 5.5%, avoidance of anticholinergics and cholinesterase inhibitors during anesthesia should be carefully considered in outpatient TJA, particularly in stand-alone ambulatory surgery centers. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/30956046/Identifiable_Risk_Factors_to_Minimize_Postoperative_Urinary_Retention_in_Modern_Outpatient_Rapid_Recovery_Total_Joint_Arthroplasty L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(19)30238-4 DB - PRIME DP - Unbound Medicine ER -