Matthew J. Mathew, MD1 William M. Mihalko, MD, PhD1 Tyler Ragsdale, MD2 Zachary Pharr, MD1 Carson Rider, MD1 Patrick C. Toy, MD1 1
2
University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee Washington University St. Louis, Missouri
Frequency of and Risk Factors for Postoperative Urinary Retention (POUR) after Total Hip Arthroplasty: Study of 409 Arthroplasties Background Total joint arthroplasty has seen a practice shift in the past few years as more surgeons begin to perform total hip and total knee arthroplasties in the Ambulatory Surgery Center (ASC). One reasons for delay in discharge to home is postoperative urinary retention (POUR). In this study, we defined POUR as the inability to urinate that required either intermittent catheterization or indwelling catheterization following total joint arthroplasty surgery.
Methods and Results Following Institutional Review Board (IRB) approval, a retrospective record review was conducted of 409 total hip arthroplasties (357 patients) done in an ASC with a direct anterior approach. Among these patients, POUR occurred in two patients (0.5%); one patient was treated with a straight catheter inserted in the postoperative anesthesia care unit (PACU) and was able to void with control, and one patient ultimately required an indwelling catheter before discharge. Factors associated with POUR included older age, amount of time spent in the ASC, and intraoperatively albumin volume administered. The two patients who developed POUR had an average body mass index (BMI) of 26.85, average age of 60 years, average albumin volume administered of 750 milliliters, average surgical time of 1.09 hours, average operative time of 1.73 hours, and average time spent in the ASC of 20.04 hours. No significant differences were found in BMI, preoperative hematocrit, estimated blood loss, surgical time, or operating time. No significant associations were found with gender, race, coronary artery disease, hyperlipidemia, congestive heart failure, hypertension, diabetes mellitus, obstructive sleep apnea, presence of a mood disorder, renal disease, alcohol use, current or history of tobacco use, laterality, American Society Anesthesiologist (ASA) score, type of anesthesia, anti-emetics given in the PACU, Bethanechol given in the PACU, or opiates given in the PACU.
Conclusions Corresponding Author
Our results suggest that POUR is an infrequent occurrence and can be safely managed when it does occur.
Patrick C. Toy, MD 1458 W. Poplar Avenue, Suite 100 Collierville, TN 38017 P: 901-759-5537 F: 901-435-5653 ptoy@campbellclinic.com
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CAMPBELL ORTHOPAEDIC JOURNAL • VOLUME 7, 2021
