Colorado Joint Replacement, Denver, CO; Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC.
Colorado Joint Replacement, Denver, CO; Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
J Arthroplasty. 2021 Jul;36(7S):S345-S350. doi: 10.1016/j.arth.2021.02.043. Epub 2021 Feb 20.
Postoperative urinary retention (POUR) after total knee arthroplasty (TKA) may cause urologic injury and delay patient discharge. This study measures the incidence of POUR and identifies predictive risk factors.
Two-hundred seventy-one consecutive patients undergoing primary unilateral TKA were prospectively enrolled. Bladder scans were performed in the postanesthesia care unit (PACU) and every four hours thereafter. POUR was defined as >400cc with inability to void and was treated with catheterization. Patient demographics, urologic history, operative data, perioperative medications, and bladder scanner volumes were investigated with the univariate and multivariate logistic regression analysis.
Fifty-five patients (20%) developed POUR. Compared with non-POUR patients, PACU bladder scan volumes were greater in patients who developed POUR (344cc vs 120cc, P < .001). POUR patients had lower BMI (27.8 vs 29.4, P = .03), longer operative duration (83.9 vs 76.0 minutes, P = .002), and lower ASA scores (2.2 vs 2.4, P = .02). Total intravenous fluid was equivalent between groups (1134cc vs 1185cc, P = .41). POUR patients received less narcotics measured by morphine milligram equivalents (16.1 vs 23.9, P < .001). Fifteen variables including spinal type (bupivacaine and ropivacaine) and paralytic use were not predictive of POUR. Potentially predictive variables included anesthetic types administered (spinal, general, regional, and combination) and perioperative administration of nonsteroidal anti-inflammatory drugs (NSAIDs), glycopyrrolate, and muscle relaxants. The multivariate analysis showed that NSAIDs (P = .05) and glycopyrrolate (P = .04) were significant predictors.
A significant percentage of patients develop POUR after TKA. Select patient demographics and PACU bladder scanning may identify those at risk. Appropriate pain control and judicious use of perioperative NSAIDs and glycopyrrolate may help minimize the risk of POUR.
全膝关节置换术后（TKA）后发生尿潴留（POUR）可能导致泌尿系统损伤并延迟患者出院。本研究测量了 POUR 的发生率，并确定了预测性危险因素。
前瞻性纳入 271 例接受单侧初次 TKA 的连续患者。在麻醉后护理病房（PACU）和此后每 4 小时进行膀胱扫描。POUR 定义为>400cc 且无法排尿，并采用导尿治疗。通过单变量和多变量逻辑回归分析研究患者的人口统计学、泌尿系统病史、手术数据、围手术期用药和膀胱扫描仪容量。
55 例（20%）患者发生 POUR。与非 POUR 患者相比，发生 POUR 的患者 PACU 膀胱扫描量更大（344cc 比 120cc，P<.001）。POUR 患者的 BMI 较低（27.8 比 29.4，P=.03）、手术时间较长（83.9 比 76.0 分钟，P=.002）、ASA 评分较低（2.2 比 2.4，P=.02）。两组间总静脉输液量相当（1134cc 比 1185cc，P=.41）。POUR 患者接受的吗啡等效剂量（mg 吗啡当量）较少（16.1 比 23.9，P<.001）。包括脊髓类型（布比卡因和罗哌卡因）和使用肌松剂在内的 15 个变量均不能预测 POUR。潜在的预测变量包括给予的麻醉类型（脊髓、全身、区域和联合）以及围手术期使用非甾体抗炎药（NSAIDs）、格隆溴铵和肌松剂。多变量分析显示 NSAIDs（P=.05）和格隆溴铵（P=.04）是显著预测因素。
相当一部分 TKA 后患者发生 POUR。选择患者的人口统计学特征和 PACU 膀胱扫描可能有助于识别高危患者。适当的疼痛控制和明智地使用围手术期 NSAIDs 和格隆溴铵可能有助于降低 POUR 的风险。
