年龄增加和术中输注液体量可预测择期腹股沟疝修补术后尿潴留。
Increased age and the volume of intraoperative fluid administered predict urinary retention after elective inguinal herniorrhaphy.
作者信息
Wu Jin-Ming, Yeh Chi-Chuan, Wei Nathan, Tsai Hsing-Hua, Tseng Shang-Ming, Chan Kuang-Cheng, Chen Kuo-Hsin
机构信息
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC.
Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Rd., Taipei, 10002, Taiwan, ROC.
出版信息
Perioper Med (Lond). 2024 Aug 19;13(1):90. doi: 10.1186/s13741-024-00446-z.
BACKGROUND
Inguinal hernia repair (IHR) is a common surgical procedure worldwide. Although IHR can be performed by the minimally invasive method, which accelerates recovery, postoperative urinary retention (POUR) remains a common complication that significantly impacts patients. Thus, it is essential to identify the risk factors associated with POUR to diminish its negative impact.
METHODS
We conducted a single-center retrospective review of elective IHR from 2018 to 2021. POUR was defined as the postoperative use of straight catheter or placement of an indwelling catheter to relieve the symptoms. Adjusted multivariate regression analysis was performed to address the associations of clinicodemographic, surgical, and intraoperative factors with POUR.
RESULTS
A total of 946 subjects were included in the analysis after excluding cases of emergent surgery, recurrent hernia, or concomitant operations. The median age was 68.4 years, and 92.0% of the patients were male. Twenty-three (2.4%) patients developed POUR. In univariate analysis, POUR in comparison with non-POUR was significantly associated with increased age (72.2 versus 68.3 years, P = 0.012), a greater volume of intraoperative fluid administered (500 versus 400 ml, P = 0.040), and the diagnosis with benign prostate hypertrophy (34.8% versus 16.9%, P = 0.025). In the multivariate model, both increased age (odds ratio [OR] 1.04, 95% CI 1.01-1.08; P = 0.049) and a greater volume of intraoperative fluid administered (OR 1.12 per 100-mL increase, 95% CI 1.01-1.27; P = 0.047) were significantly associated with the occurrence of POUR.
CONCLUSIONS
We found that increased age and a greater volume of intraoperative fluid administered were significantly associated with the occurrence of POUR. Limiting the administration of intraoperative fluid may prevent POUR. From the perspective of practical implications, specific guidelines or clinical pathways should be implemented for fluid management and patient assessment.
背景
腹股沟疝修补术（IHR）是全球常见的外科手术。尽管IHR可通过微创方法进行，从而加速康复，但术后尿潴留（POUR）仍是一种常见并发症，会对患者产生重大影响。因此，识别与POUR相关的危险因素以减轻其负面影响至关重要。
方法
我们对2018年至2021年的择期IHR进行了单中心回顾性研究。POUR定义为术后使用直导管或留置导管以缓解症状。进行了校正多因素回归分析，以探讨临床人口统计学、手术和术中因素与POUR的关联。
结果
排除急诊手术、复发性疝或同期手术病例后，共有946名受试者纳入分析。中位年龄为68.4岁，92.0%的患者为男性。23名（2.4%）患者发生POUR。在单因素分析中，与未发生POUR相比，POUR与年龄增加（72.2岁对68.3岁，P = 0.012）、术中补液量增加（500 ml对400 ml，P = 0.040）以及良性前列腺增生诊断（34.8%对16.9%，P = 0.025）显著相关。在多因素模型中，年龄增加（比值比[OR] 1.04，95%可信区间1.01 - 1.08；P = 0.049）和术中补液量增加（每增加100 ml，OR 1.12，95%可信区间1.01 - 1.27；P = 0.047）均与POUR的发生显著相关。
结论
我们发现年龄增加和术中补液量增加与POUR的发生显著相关。限制术中补液量可能预防POUR。从实际意义的角度来看，应实施特定的液体管理和患者评估指南或临床路径。
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