Department of Orthopedics, Indiana University Health Orthopedics, Fishers, IN.
Anesthesia Consultants of Indiana LLC, Indianapolis, IN.
J Arthroplasty. 2019 Jul;34(7S):S343-S347. doi: 10.1016/j.arth.2019.03.015. Epub 2019 Mar 12.
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.
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.
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.
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.
全关节置换术后（TJA）发生尿潴留（POUR），这对门诊和早期出院 TJA 构成了重大障碍。本研究旨在调查一个现代、基于循证医学、门诊和早期出院 TJA 方案中，急性 POUR 的发生率和危险因素。
对 685 例连续单侧 TJA 术后当天或次日出院的患者进行前瞻性记录数据，回顾性分析。POUR 通过围手术期内科专家进行诊断。对潜在预测因子进行单变量分析，然后对 P≤.25 的预测因子进行二元逻辑回归（BLR）检验。
排除混杂因素后，最终分析样本包括 633 例手术。POUR 的总发生率为 5.5%（当日出院者为 3.9%）。男性、尿潴留史、使用罗库溴铵、使用格隆溴铵、使用新斯的明、芬太尼脊髓麻醉和未留置导尿管与急性 POUR 相关，并符合进入多变量 BLR 的标准。17 个额外的预测因子，包括肾脏疾病和门诊手术与 POUR 无关。在最终的 BLR 模型中（P=0.001），接受格隆溴铵和新斯的明的男性患者发生 POUR 的概率为 34%，在没有这些危险因素的情况下，这一概率下降至 2.8%。
尽管发生率相对较低（5.5%），但在门诊 TJA 中，特别是在独立的日间手术中心，麻醉期间应谨慎考虑避免使用抗胆碱能药物和胆碱酯酶抑制剂。
