Sultan Assem A, Berger Ryan J, Cantrell William A, Samuel Linsen T, Ohliger Erin, Golubovsky Joshua, Bachour Salam, Pasadyn Selena, Karnuta Jaret M, Tamer Pierre, Le Phuc, Kuivila Thomas E, Gurd David P, Goodwin Ryan C
Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue NA21, Cleveland, OH, 44195, USA.
Spine Deform. 2020 Apr;8(2):195-201. doi: 10.1007/s43390-020-00039-y. Epub 2020 Jan 24.
In adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal instrumented fusion (PSIF), we aimed to answer these questions: (1) is there a difference in postoperative urinary retention (UR) rates among patients who had removal of their Foley catheters before vs. after discontinuation of epidural analgesia (EA)? (2) Can the timing of Foley catheter removal be an independent risk factor for postoperative UR requiring recatheterization? (3) Is there an incurred cost related to treating UR?
Retrospective cohort.
EA has been widely used for postoperative pain control after PSIF for AIS. In these patients, removing the Foley catheter, inserted for intraoperative monitoring of urine output, is indicated in the early postoperative period. However, a controversy exists as to whether it should be removed before or after the EA has been discontinued.
A single-institution, longitudinally maintained database was queried to identify 297 patients who met specific inclusion and exclusion criteria. Patient characteristics and the order and timing of removing the urinary and epidural catheters were collected. Rates of UR were statistically compared in patients who had early vs. late urinary catheter removal. A univariate and multivariate regression analysis was conducted to identify independent risk factors. Hospital episode costs were analyzed.
Patients who had early (n = 66, 22%) vs. late (n = 231, 78%) urinary catheter removal had a significantly higher incidence of UR requiring recatheterization (15 vs. 4.7%, p = 0.007). Patient with early removal were almost 4 times more likely to develop UR requiring recatheterization [odds ratio (OR) 3.8, 95% confidence interval (CI) 1.5-9.7, p = 0.005]. UR incurred additional costs averaging $15,000/patient (p = 0.204).
In patients who had PSIF for AIS, removal of a urinary catheter before discontinuation of EA is an independent risk factor for UR, requiring recatheterization and associated with increased cost.
III.
在接受后路脊柱内固定融合术（PSIF）的青少年特发性脊柱侧凸（AIS）患者中，我们旨在回答以下问题：（1）在硬膜外镇痛（EA）停用之前与之后拔除 Foley 导管的患者，术后尿潴留（UR）发生率是否存在差异？（2）Foley 导管拔除时间能否成为术后需要重新插管的 UR 的独立危险因素？（3）治疗 UR 是否会产生相关费用？
回顾性队列研究。
EA 已广泛用于 AIS 患者 PSIF 术后的疼痛控制。在这些患者中，为术中监测尿量而插入的 Foley 导管，在术后早期即需拔除。然而，对于应在 EA 停用之前还是之后拔除导管存在争议。
查询一个单机构纵向维护的数据库，以识别 297 例符合特定纳入和排除标准的患者。收集患者特征以及拔除导尿管和硬膜外导管的顺序与时间。对早期与晚期拔除导尿管的患者的 UR 发生率进行统计学比较。进行单因素和多因素回归分析以确定独立危险因素。分析住院期间费用。
早期（n = 66，22%）与晚期（n = 231，78%）拔除导尿管的患者中，需要重新插管的 UR 发生率显著更高（分别为 15%与
