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- Title
RISK FACTORS FOR URINARY RETENTION AFTER HIP OR KNEE REPLACEMENT.
- Authors
Neufeld, Jeremy; Greisdale, Donald; Dhillon, Dale; Joo, Jennifer; Sandhu, Supna; Swinnton, Frank; Choi, Peter
- Abstract
INTRODUCTION: Hip and knee replacements are two of the most commonly performed surgical procedures in developed countries. The rates of these procedures have increased with the aging of the Canadian population but wait times continue to be long. In 2006, our provincial government initiated a program to reduce wait times by referring elective patients to a single tertiary-care centre. This program provided an opportunity to identify risk factors for common perioperative complications as part of a continuing quality improvement project. We report the incidence rate of postoperative urinary retention after hip and knee replacements and the risk factors associated with this complication. METHODS: After local Research Ethics Board approval, data were abstracted from a random sample of charts of patients who underwent elective primary unilateral total hip replacement (THR) or total knee replacement (TKR) surgery in the first 13 months of the program. When patients underwent more than one joint replacement during the study period, we collected data from the first procedure only. Variables included demographics, comorbid conditions, medications, anesthetic details, times, and postoperative complications in the first 24 h after surgery. We defined postoperative urinary retention as urinary catheterization due to inability to void or ultrasound evidence of bladder distention after unsuccessful attempts to void. Stata release 10 (StataCorp, Texas, USA) was used for data analysis. Normally distributed and skewed data were described by means (standard deviation [SD]) and median (interquartile range [IQR]) respectively. Risk factors were identified using multivariable logistic regression. Risks were expressed as odds ratios [OR] (95% confidence intervals [CI]). A p-value of <0.05 was considered to be significant. RESULTS: From April 1, 2006 to May 31, 2007, 1440 patients underwent 1515 elective THR or TKR. We abstracted data from 1031 (71.3%) patients [age 62 y (IQR 55-70); 53.7% female; 605 THR, 426 TKR]. Procedures were performed under spinal anesthesia (n=844, 81.8%), general anesthesia (n=105, 10.2%), or combined spinal and general anesthesia (n=82, 8.0%). Patients spent 100 min (IQR 90-114 min) in the operating room and 3 days (IQR 3-4 days) in hospital. The 24-h incidence of postoperative urinary retention was 43.3% (446/1031). Male sex (OR 3.9, 95% CI 3.0-5.2) and intrathecal morphine [≤100 mcg (OR 3.7, 95% CI 2.2-6.3); 101-150 mcg (OR 5.5, 95% CI 3.1-10.0); >150 mcg (OR 4.0, 95% CI 2.0-8.0)] were risk factors for urinary retention (all p<0.001). DISCUSSION: Postoperative urinary retention is a common complication after THR or TKR, especially amongst men and patients receiving intrathecal morphine. Intraoperative urinary catheterization should be considered to prevent this complication.
- Subjects
URINATION disorders; TOTAL hip replacement; TOTAL knee replacement; URINARY catheterization; JOINT surgery; PREOPERATIVE risk factors; URINATION
- Publication
UBC Medical Journal, 2011, Vol 2, Issue 2, p22
- ISSN
1920-7425
- Publication type
Abstract