Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, GRC 001, GREEN Groupe de recherche en Neuro-Urologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Rothschild, 5, rue Santerre, 75012 Paris, France.
Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
Ann Phys Rehabil Med. 2021 Nov;64(6):101464. doi: 10.1016/j.rehab.2020.101464. Epub 2021 Oct 26.
Postoperative urinary retention (POUR) is a common hip fracture (HF) complication. Although fecal impaction (FI) is one of the oft-cited causes of POUR in clinical practice, evidence regarding this association is scarce.
The aim of this study was to determine whether FI was associated with POUR after HF surgery in older patients.
All patients consecutively admitted after a HF surgery in a geriatric perioperative unit were included in this cross-sectional study. FI was systematically assessed by a digital rectal exam at admission and according to clinical suspicion during the hospital stay. The dependent variable was POUR, systematically screened according to the department protocol and defined as a bladder volume>400ml requiring catheterization. The association between FI and POUR was assessed by multivariable analysis.
A total of 256 patients were included (mean [SD] age 86 [6] years), (76% women): 108 (42%) presented FI and 63 (25%) POUR. The frequency of FI was higher with than without POUR (73% vs. 32%, P<0.001). On multivariable analysis, after adjusting for age, sex, Cumulative Illness Rating Scale score and anticholinergic load, FI was the only factor independently associated with POUR (odds ratio 4.78) [95% confidence interval 2.44-9.71], P<0.001.
FI was the only independent factor associated with POUR after HF surgery in older adults. Further studies are needed to optimize perioperative geriatric care including FI and POUR assessment and management.
术后尿潴留（POUR）是髋部骨折（HF）的常见并发症。虽然在临床实践中，粪嵌塞（FI）是导致 POUR 的一个常见原因，但关于这种关联的证据很少。
本研究旨在确定 FI 是否与老年 HF 手术后 POUR 相关。
本横断面研究纳入了在老年围手术期病房接受 HF 手术后连续入院的所有患者。FI 通过入院时的直肠指检和住院期间的临床怀疑进行系统评估。依赖变量是 POUR，根据科室方案进行系统筛查，并定义为膀胱容量>400ml 需要导尿的情况。通过多变量分析评估 FI 和 POUR 之间的关联。
共纳入 256 例患者（平均[标准差]年龄 86[6]岁），（76%为女性）：108 例（42%）存在 FI，63 例（25%）存在 POUR。有 POUR 的患者 FI 频率高于无 POUR 的患者（73% vs. 32%，P<0.001）。多变量分析调整年龄、性别、累积疾病评分和抗胆碱能负荷后，FI 是唯一与 POUR 独立相关的因素（比值比 4.78[95%置信区间 2.44-9.71]，P<0.001）。
FI 是老年人 HF 手术后 POUR 的唯一独立相关因素。需要进一步研究以优化包括 FI 和 POUR 评估和管理在内的围手术期老年护理。
