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Predictive factors of early postoperative urinary retention in the postanesthesia care unit
Hawa Keita1, Elisabeth Diouf, Florence Tubach
1Department of Anesthesiology and Intensive Care, Hospital Bichat-Claude Bernard, Paris, France.
Insights
Postoperative urinary retention affects 16% of patients. Key predictors include higher intraoperative fluid volume, age over 50, and larger bladder volume upon PACU entry. Early ultrasound monitoring is recommended.
Area of Science:
- Anesthesiology
- Urology
- Surgical Complications
Background:
- Urinary retention is a common postoperative complication.
- It can lead to bladder overdistension and potential detrusor damage.
- Early identification of risk factors is crucial for prevention.
Purpose of the Study:
- To identify predictive factors for early postoperative urinary retention.
- To assess the incidence of urinary retention in the postanesthesia care unit (PACU).
Main Methods:
- Prospective study of 313 adult patients.
- Data collected: age, gender, surgical/anesthesia type, medications, fluid administration, morphine titration, and bladder volume.
- Bladder volume measured by ultrasound on PACU entry and before discharge.
- Urinary retention defined as bladder volume >600 mL with inability to void within 30 min.
Main Results:
- 16% incidence of postoperative urinary retention in the PACU.
- Independent predictors identified: intraoperative fluid volume (≥750 mL), age (≥50 yr), and bladder volume on PACU entry (≥270 mL).
- Increased odds ratios associated with these factors.
Conclusions:
- Age, intraoperative fluid volume, and initial bladder volume are significant predictors of postoperative urinary retention.
- Systematic bladder volume assessment using portable ultrasound in the PACU is suggested, especially for at-risk patients.
Unlabelled:
Urinary retention is a common postoperative complication associated with bladder overdistension and the risk of permanent detrusor damage. The goal of this study was to determine predictive factors of early postoperative urinary retention in the postanesthesia care unit (PACU). We prospectively collected, in 313 adult patients, variables including age, gender, previous history of urinary tract symptoms, type of surgery and anesthesia, intraoperative administration of anticholinergics, amount of intraoperative fluids, IV morphine titration, and bladder volume on entry to the PACU. For each patient, bladder volume was measured by ultrasound on entry and before discharge from the PACU. Urinary retention was defined as a bladder volume larger than 600 mL with an inability to void within 30 min. Predictive factors were identified by multivariate analysis. The incidence of urinary retention in the PACU was 16%. In the multivariate analysis only the amount of intraoperative fluids (>or=750 mL; P = 0.02; odds ratio = 2.3), age (>or=50 yr; P = 0.008; odds ratio = 2.4), and bladder volume on entry to PACU (>or=270 mL; P = 0.0001; odds ratio = 4.8) were found to independently increase the risk of urinary retention. Considering the clinical impact of undiagnosed postoperative urinary retention, these results suggest systematic evaluation of bladder volume with a portable ultrasound device in the PACU, especially in patients with risk factors.
Implications:
In this observational study, the ultrasound monitoring of bladder volume in the postanesthesia care unit (PACU) revealed that postoperative urinary retention occurred with an incidence of 16%. Age (>or=50 yr), amount of intraoperative fluid volume (>or=750 mL), and bladder volume on entry to PACU (>or=270 mL) were independent predictive factors for this complication.
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