after Total Hip Arthroplasty: Study of 409 Arthroplasties

Matthew J. Mathew, MD1 William M. Mihalko, MD, PhD1 Tyler Ragsdale, MD2 Zachary Pharr, MD1 Carson Rider, MD1 Patrick C. Toy, MD1

1 University of Tennessee-Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering Memphis, Tennessee 2 Washington University

St. Louis, Missouri

Corresponding Author

Patrick C. Toy, MD

1458 W. Poplar Avenue, Suite 100 Collierville, TN 38017 P: 901-759-5537 F: 901-435-5653 ptoy@campbellclinic.com

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 defi ned 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 signifi cant di erences were found in BMI, preoperative hematocrit, estimated blood loss, surgical time, or operating time. No signifi cant 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

Our results suggest that POUR is an infrequent occurrence and can be safely managed when it does occur.

MATT “JEJO” MATHEW, MD

Hometown: Olathe, Kansas Undergraduate Institution: University of Kansas Medical School: University of Kansas School of Medicine Dr. Mathew is the youngest of three brothers, and is the fi rst in his family to pursue a medical career. When asked why he chose medicine as a career: Despite fulfi lling the stereotype of working with computers my entire life, I fell in love with medicine after shadowing a few physicians during high school. Watching them develop lasting relationships with their patients and ultimately seeing the progress patients made during their hospital stay or after surgery was something that I wanted to be a part of. And why he chose orthopaedics as a specialty: I had an ACL reconstruction on my right knee during college (I was, what you would call, an elite athlete back then). After that, I ended up shadowing my orthopaedic surgeon who did my surgery and saw fi rst hand the rapport he developed with patients and loved every minute of doing surgical cases with him. It was after that point that I knew I belonged in the operating room and ultimately loved being involved in the preoperative, intraoperative, and postoperative aspects of patient care. Plans After Campbell: Dr. Mathew will be pursuing an Adult Reconstruction Fellowship at the NorthShore Orthopaedic Institute in Chicago. Dr. Mathew adds: Thank you to all of the Joints faculty (Guyton, Harkess, Ford, Crockarell, and Mihalko) for mentoring me all these years and showing me that joint replacements actively made the biggest diff erence in patients’ lives. Thank you to all of the Trauma staff at the Med (Weinlein, Rudloff , Beebe, Whittle and Cosgrove) for continuing to support us on the trauma rotation. I have continued to tell residents at other institutions that we have the best trauma experience in the country, and my experience has been well representative of that. Lastly, a big thank you to “The Offi ce” downtown for sponsoring my weekends during the fi ve years of residency.