Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMC Geriatr. 2024 Jun 3;24(1):483. doi: 10.1186/s12877-024-05101-2.
Postoperative urinary retention (POUR) among older patients with hip fractures is common and may result in delayed ambulation, prolonged hospital stays, and urinary tract infections. Although preoperative urinary catheter indwelling and early postoperative removal can prevent perioperative urinary retention, this condition may occur in some patients after catheter removal, which requires urinary catheter re-indwelling or intermittent catheterization. Therefore, this study aims to identify risk factors and develop a screening tool for postoperative urinary retention in patients who have undergone operative treatment for fragility hip fractures subsequent to urinary catheter removal.
A prospective cohort study of 145 fragility hip fracture in older patients who were operatively treated between September 2020 and May 2022 was conducted. All patients were evaluated for urine retention after urinary catheter removal using a bladder scan. In addition, factors related to urinary retention were collected and utilized for screening tool development.
Of the included patients, 22 (15.2%) were diagnosed with POUR. A multivariable logistic regression model using a stepwise backward elimination algorithm identified the current use of drugs with anticholinergic effect (OR = 11.9, p = 0.012), international prostate symptom score (IPSS) ≥ 8 (OR = 9.3, p < 0.001), and inability to independently get out of bed within 24 h postoperatively (OR = 6.5, p = 0.051) as risk factors of POUR. The screening tool that has been developed revealed an excellent performance (AuROC = 0.85, 95%CI 0.75 to 0.91) with good calibration and minimal optimism.
Current use of drugs with anticholinergic effects, IPSS ≥ 8, and inability to independently get out of bed within 24 h postoperatively are significant variables of POUR. For additional external validation, a proposed scoring system for POUR screening was developed.
The study protocol was retrospectively registered in The Thai Clinical Trials Registry (TCTR20220502001: 2 May 2022).
老年髋部骨折患者术后尿潴留（POUR）很常见，可能导致术后活动延迟、住院时间延长和尿路感染。虽然术前留置导尿管和术后早期拔除导尿管可以预防围手术期尿潴留，但一些患者在拔除导尿管后仍可能发生这种情况，需要再次留置导尿管或间歇性导尿。因此，本研究旨在确定术后尿潴留的危险因素，并为接受手术治疗的脆性髋部骨折患者开发一种术后尿潴留筛查工具。
对 2020 年 9 月至 2022 年 5 月期间接受手术治疗的 145 例老年脆性髋部骨折患者进行前瞻性队列研究。所有患者在拔除导尿管后均采用膀胱扫描评估是否存在尿潴留。此外，还收集了与尿潴留相关的因素，并用于筛查工具的开发。
纳入的患者中，22 例（15.2%）被诊断为 POUR。采用逐步向后消除算法的多变量逻辑回归模型确定了当前使用具有抗胆碱能作用的药物（OR=11.9，p=0.012）、国际前列腺症状评分（IPSS）≥8（OR=9.3，p<0.001）和术后 24 小时内无法独立下床（OR=6.5，p=0.051）是 POUR 的危险因素。开发的筛查工具具有良好的性能（AuROC=0.85，95%CI 0.75 至 0.91），校准良好，最小化了乐观性。
当前使用具有抗胆碱能作用的药物、IPSS≥8 和术后 24 小时内无法独立下床是 POUR 的显著变量。为了进一步的外部验证，开发了一种用于 POUR 筛查的建议评分系统。
该研究方案在泰国临床试验注册中心（TCTR20220502001：2022 年 5 月 2 日）进行了回顾性注册。
