Carlock Kurtis D, Mills Zachary D, Geiger Kyle W, Manner Paul A, Fernando Navin D
Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA.
Arthroplast Today. 2022 May 28;16:68-72. doi: 10.1016/j.artd.2022.04.015. eCollection 2022 Aug.
Perioperative indwelling urinary catheterization remains common in patients undergoing total hip arthroplasty. This study sought to examine the effect of routine catheterization following total hip arthroplasty performed under spinal anesthesia on urinary complications.
A total of 991 consecutive patients who underwent primary total hip arthroplasty under spinal anesthesia over a 4-year period were retrospectively reviewed. Major postoperative urinary retention (POUR) was defined as persistent retention following 2 straight catheterizations, which required postoperative indwelling catheter placement. Minor POUR was defined as retention that resolved following 1 or 2 straight catheterizations. Statistical analyses were used to compare outcomes between those who received a routine indwelling catheter and those who did not.
Of the 991 patients included, 498 (50.3%) underwent routine indwelling urinary catheter placement preoperatively. Routine indwelling catheterization was associated with a higher rate of urinary tract infection (1.4% vs 0.0%, = .015), but a lower rate of minor POUR (5.0% vs 10.3%, = .001). There was no difference with respect to the rate of major POUR or discharge with an indwelling catheter. Multivariate analyses demonstrated indwelling catheterization to be independently associated with a lower rate of minor POUR ( = .021), but there was no association with overall POUR, major POUR, or discharge with a urinary catheter.
These data suggest that routine indwelling urinary catheterization is likely unnecessary for patients undergoing total hip arthroplasty in the setting of spinal anesthetic and may even lead to increased risk of complications such as urinary tract infection.
围手术期留置导尿在全髋关节置换术患者中仍然很常见。本研究旨在探讨在脊髓麻醉下行全髋关节置换术后常规导尿对泌尿系统并发症的影响。
回顾性分析了4年间连续接受脊髓麻醉下初次全髋关节置换术的991例患者。术后严重尿潴留（POUR）定义为连续两次导尿后仍持续潴留，需要术后留置导尿管。轻度POUR定义为经1次或2次导尿后缓解的潴留。采用统计学分析比较接受常规留置导尿管和未接受常规留置导尿管患者的结局。
在纳入的991例患者中，498例（50.3%）术前接受了常规留置导尿。常规留置导尿与较高的尿路感染率相关（1.4%对0.0%，P = 0.015），但轻度POUR发生率较低（5.0%对10.3%，P = 0.001）。在严重POUR率或留置导尿管出院方面没有差异。多因素分析表明，留置导尿与较低的轻度POUR发生率独立相关（P = 0.021），但与总体POUR、严重POUR或导尿管出院无关。
这些数据表明，对于在脊髓麻醉下进行全髋关节置换术的患者，常规留置导尿可能没有必要，甚至可能导致尿路感染等并发症风险增加。
