Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, MI.
J Arthroplasty. 2019 Oct;34(10):2324-2328. doi: 10.1016/j.arth.2019.05.047. Epub 2019 Jun 20.
The objective of this study was to evaluate if not placing an indwelling urinary catheter leads to a higher potential for adverse genitourinary (GU) issues after total joint arthroplasty (TJA) under epidural anesthesia.
Three hundred thirty-five consecutive patients who underwent primary TJA using epidural anesthesia were retrospectively reviewed. The initial 103 patients received a preoperative urinary catheter, which was maintained until the morning of postoperative day 1. The subsequent 232 patients did not receive a preoperative urinary catheter. Demographics, medical complications, GU complications, and length of stay were compared between groups.
Compared between catheter and noncatheter groups, there were no differences in demographics including age, gender, or laterality of surgery. There was a difference in type of surgery (total knee arthroplasty vs total hip arthroplasty) (P = .008). There was no difference in American Society of Anesthesiologists score, but with a difference in body mass index (P = .01). There were no differences in GU complications among patients with benign prostatic hyperplasia or prostate cancer. However, among patients with a history of prostate disorders (benign prostatic hyperplasia or prostate cancer), urinary tract infection rate was higher in catheter group (P = .023). Postoperative GU complications were associated with increased median age in years and increased average length of stay in days.
Patients undergoing TJA under epidural anesthesia demonstrate no increased risk of postoperative urological complications without the placement of preoperative indwelling urinary catheter. The routine use of preoperative catheters can be reconsidered for this mode of anesthesia.
Level II, retrospective comparative study.
本研究旨在评估在硬膜外麻醉下进行全关节置换术后，不留置导尿管是否会增加泌尿生殖系统（GU）不良问题的风险。
回顾性分析了 335 例连续接受硬膜外麻醉下初次全关节置换术的患者。最初的 103 例患者接受了术前导尿管，该导尿管一直保留到术后第 1 天早上。随后的 232 例患者未接受术前导尿管。比较两组患者的人口统计学、医疗并发症、GU 并发症和住院时间。
与导尿管组和非导尿管组相比，两组患者的年龄、性别或手术侧别无差异。手术类型（全膝关节置换术与全髋关节置换术）存在差异（P=0.008）。美国麻醉医师协会评分无差异，但体质量指数有差异（P=0.01）。良性前列腺增生或前列腺癌患者的 GU 并发症无差异。然而，在有前列腺疾病史（良性前列腺增生或前列腺癌）的患者中，导尿管组的尿路感染率更高（P=0.023）。术后 GU 并发症与年龄中位数增加和平均住院天数增加相关。
在硬膜外麻醉下接受全关节置换术的患者，不放置术前留置导尿管不会增加术后泌尿系统并发症的风险。对于这种麻醉方式，术前导尿管的常规使用可以重新考虑。
II 级，回顾性比较研究。
