Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Department of Anesthesia, Rush University Medical Center, Chicago, Illinois.
J Bone Joint Surg Am. 2023 Feb 15;105(4):312-319. doi: 10.2106/JBJS.22.00759. Epub 2022 Dec 19.
The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).
Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ≥2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ≥450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ≥1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.
Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ≥1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis.
The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.
Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
本随机对照试验的目的是确定短期 Foley 导管（在手术室插入，到达骨科楼层时取出）是否会降低接受初次全髋关节置换术（THA）和全膝关节置换术（TKA）的患者术后尿潴留（POUR）的风险。
388 名接受椎管内麻醉的住院初次 TKA（n=228）或 THA（n=160）患者被随机分为短期 Foley 导管组（n=194）或无 Foley 导管组（n=194）。其中男 143 例，女 245 例。主要结局是 POUR，定义为需要≥2 次直导管插入或膀胱扫描提示潴留≥450mL 时需要留置导尿管。次要结局包括术后 3 周内尿路感染（UTI）和需要≥1 次直导管插入。功效分析确定每组需要 194 例患者，才能在 80%的功效和 0.05 的α水平下检测到 POUR 率 7%的最小临床重要差异。采用意向治疗和实际治疗分析（2 例患者接受了非分配治疗）。使用单变量和多变量分析比较组间结局，α<0.05。
9 例发生 POUR：短期 Foley 组 4 例，对照组 5 例（2.1%比 2.6%；p=1.00）。发生 POUR 的患者中，男性 8 例，女性 1 例（88.9%比 11.1%；p=0.002）。24 例需要≥1 次直导管插入： Foley 组 10 例，对照组 14 例（5.2%比 7.2%；p=0.40）。4 例发生 UTI：Foley 组 3 例，对照组 1 例（1.5%比 0.5%；p=0.62）在意向治疗分析中，Foley 组 4 例，对照组无 1 例（2.1%比 0.0%；p=0.12）在实际治疗分析中。
在手术室插入并在到达骨科楼层时取出的短期 Foley 导管并不能降低 POUR 发生率。
治疗水平 I。有关证据水平的完整描述，请参阅作者说明。
