Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty

Mary Ziemba-Davis, Mark Nielson, Kent Kraus, Nathan Duncan, Nimra Nayyar, R. Meneghini

Research output: Contribution to journalArticle

Abstract

Background: Postoperative urinary retention (POUR) following total joint arthroplasty (TJA) presents a significant barrier to outpatient and early discharge TJA. This study examined the incidence and risk factors for acute POUR in a modern, evidence-based, outpatient, and early discharge TJA program. Methods: Prospectively recorded data on 685 consecutive primary unilateral TJAs discharged the day of or day after surgery were retrospectively reviewed. POUR was diagnosed by a perioperative internal medicine specialist. Univariate analysis of potential predictors was performed, followed by binary logistic regression (BLR) testing of predictors with P ≤.25. Results: After exclusions for confounds, the final analysis sample consisted of 633 procedures. The overall incidence of POUR was 5.5% (3.9% for same day discharges). Male gender, history of urinary retention, use of rocuronium, use of glycopryrrolate, use of neostigmine, fentanyl spinals, and the absence of an indwelling urethral catheter were associated with acute POUR and met criteria for entry into multivariate BLR. Seventeen additional predictors, including kidney disease and outpatient surgery were unrelated to POUR. In the final BLR model (P =.001), male patients who received glycopyrrolate with neostigmine had a 34% probability of developing POUR, which declined to 2.8% in the absence of these risk factors. Conclusion: Despite a relatively low incidence of 5.5%, avoidance of anticholinergics and cholinesterase inhibitors during anesthesia should be carefully considered in outpatient TJA, particularly in stand-alone ambulatory surgery centers.

Original languageEnglish (US)
JournalJournal of Arthroplasty
DOIs
StatePublished - Jan 1 2019

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Urinary Retention
Arthroplasty
Outpatients
Joints
Logistic Models
Ambulatory Surgical Procedures
Neostigmine
Glycopyrrolate
Urinary Catheters
Indwelling Catheters
Cholinesterase Inhibitors
Incidence
Kidney Diseases
Cholinergic Antagonists
Fentanyl
Internal Medicine
Cohort Studies
Anesthesia

Keywords

  • early discharge
  • hip
  • knee
  • outpatient
  • total joint
  • urinary retention

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Identifiable Risk Factors to Minimize Postoperative Urinary Retention in Modern Outpatient Rapid Recovery Total Joint Arthroplasty. / Ziemba-Davis, Mary; Nielson, Mark; Kraus, Kent; Duncan, Nathan; Nayyar, Nimra; Meneghini, R.

In: Journal of Arthroplasty, 01.01.2019.

Research output: Contribution to journalArticle

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