Kort N P, Bemelmans Y, Vos R, Schotanus M G M
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands.
Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands.
Eur J Orthop Surg Traumatol. 2018 Feb;28(2):283-289. doi: 10.1007/s00590-017-2042-5. Epub 2017 Sep 12.
Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after surgery, is a commonly reported complication. This study reports the incidence and possible risk factors for POUR after elective fast-track hip or knee arthroplasty when using a nurse-led bladder scan protocol.
This retrospective cohort study included data from 803 patients who underwent unilateral hip or knee arthroplasty. Patients' digital clinical records were reviewed for eligibility. Patients with incomplete data registration, preoperative bladder volume >250 ml, preexisting bladder catheterization, and/or patients following the outpatient pathway were excluded. Bladder volumes were assessed at different moments pre- and postoperatively. The outcome was the incidence of POUR, defined as the inability to void spontaneously with a bladder volume >600 ml, treated with indwelling catheterization. Further analysis between POUR and non-POUR patients was performed to detect possible risk factors for POUR.
Six hundred and thirty-eight patients operated on primary unilateral hip or knee arthroplasty were analyzed. The incidence of POUR was 12.9% (n = 82, 95% CI 9.4-15.5). Gender, age, BMI, ASA classification, preoperative bladder volume, type of anesthesia, type of arthroplasty, and perioperative fluid administration were not significant different between POUR and non-POUR patients. Patients with a bladder volume of >200 ml at the recovery room were at higher risk (OR 5.049, 95% CI 2.815-9.054) for POUR.
When using a nurse-led bladder scan protocol in fast-track hip and knee arthroplasty, the incidence of POUR was 12.9%, with a bladder volume of >200 ml at the recovery room as a risk factor for POUR.
A retrospective cohort study, Level III.
术后尿潴留（POUR）定义为术后无法自主排空膀胱，是一种常见的并发症。本研究报告了在采用护士主导的膀胱扫描方案时，择期快速康复髋关节或膝关节置换术后POUR的发生率及可能的危险因素。
这项回顾性队列研究纳入了803例行单侧髋关节或膝关节置换术患者的数据。对患者的数字临床记录进行资格审查。排除数据登记不完整、术前膀胱容量>250 ml、既往有膀胱插管史和/或采用门诊治疗路径的患者。在术前和术后不同时间点评估膀胱容量。结局指标是POUR的发生率，定义为膀胱容量>600 ml时无法自主排尿，并采用留置导尿治疗。对发生POUR和未发生POUR的患者进行进一步分析，以检测POUR可能的危险因素。
对638例行初次单侧髋关节或膝关节置换术的患者进行了分析。POUR的发生率为12.9%（n = 82，95%CI 9.4-15.5）。POUR患者和未发生POUR的患者在性别、年龄、体重指数、美国麻醉医师协会（ASA）分级、术前膀胱容量、麻醉类型、关节置换类型和围手术期液体输注方面无显著差异。恢复室时膀胱容量>200 ml的患者发生POUR的风险更高（OR 5.049，95%CI 2.815-9.054）。
在快速康复髋关节和膝关节置换术中采用护士主导的膀胱扫描方案时，POUR的发生率为12.9%，恢复室时膀胱容量>200 ml是POUR的一个危险因素。
一项回顾性队列研究，三级证据。
