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Changes in Anesthesia Can Reduce Periprocedural Urinary Retention After EVAR.
Andres Guerra1, Calvin Chao1, Gabriel A Wallace1
1Northwestern Feinberg School of Medicine, Division of Vascular Surgery, Surgery Department, Chicago, Illinois.
Annals of Vascular Surgery
|October 23, 2021
Summary
Monitored anesthetic care (MAC) plus local anesthesia reduced postoperative urinary retention (POUR) in male patients undergoing endovascular aortic repair (EVAR). Implementing MAC can decrease POUR rates and shorten hospital stays for these patients.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Patient Recovery
Background:
- Enhanced Recovery After Surgery (ERAS) programs optimize postoperative care for high-volume procedures.
- Endovascular Aortic Repair (EVAR) is a standard treatment for abdominal aortic aneurysms.
- Postoperative Urinary Retention (POUR) is a common complication leading to prolonged hospital stays.
Purpose of the Study:
- To evaluate the effectiveness of monitored anesthetic care (MAC) plus local anesthesia in minimizing POUR after EVAR.
- To compare POUR rates between general anesthesia and MAC anesthesia in EVAR patients.
Main Methods:
- Retrospective review of 138 patients undergoing elective EVAR (January 2017-March 2020).
- Patients received either general anesthesia or MAC with local anesthesia.
- POUR was defined as the need for catheterization; predictors of POUR and length of stay were analyzed.
Main Results:
- Male patients under general anesthesia had higher rates of intra-operative urinary catheter placement (82.5% vs. 36% for MAC).
- POUR occurred in 13.1% of patients, predominantly males (88.2%).
- MAC anesthesia was associated with a significantly lower risk of developing POUR (OR 0.09).
Conclusions:
- MAC plus local anesthesia is linked to reduced POUR rates in male patients undergoing elective EVAR.
- ERAS protocols for EVAR should consider MAC as an anesthetic option to decrease POUR and hospital stay.
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