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Spinal Anesthetic Type and Independent Risk Factors for Postoperative Urinary Retention Following Total Joint
Andrew W Kuhn1, Jonathan R Lynch2, Carolyn G Ahlers3
1Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
Journal of Surgical Orthopaedic Advances
|January 8, 2021
Summary
Postoperative urinary retention (POUR) after total joint arthroplasty (TJA) is not linked to spinal anesthetic type. However, mepivacaine was associated with a shorter hospital stay, though this effect disappeared after adjustments.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Urology
Background:
- Postoperative urinary retention (POUR) is a known complication after total joint arthroplasty (TJA).
- Risk factors for POUR are established, but the influence of different spinal anesthetic agents remains unclear.
Purpose of the Study:
- To investigate the association between spinal anesthetic type and the incidence of POUR following TJA.
- To evaluate the impact of anesthetic choice on length of stay (LOS) after TJA.
Main Methods:
- Retrospective review of 1054 patients undergoing primary TJA between 2013-2018.
- Comparison of POUR rates and LOS between patients receiving bupivacaine versus mepivacaine for spinal anesthesia.
- Statistical analysis controlling for demographic and intraoperative variables.
Main Results:
- No significant difference in POUR rates between bupivacaine (5.5%) and mepivacaine (6.1%) groups (p = 0.675).
- Patients receiving mepivacaine had a shorter LOS (1 day vs. 2 days, p < 0.001), but this was not significant after controlling for confounders.
- Older age and a history of benign prostatic hyperplasia or urinary incontinence/retention were confirmed independent risk factors for POUR.
Conclusions:
- Spinal anesthetic type (bupivacaine vs. mepivacaine) is not significantly associated with POUR after TJA.
- Older age and pre-existing urinary issues are key risk factors for POUR in TJA patients.
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