Catheterizations Reduced Following a Protocol Change for Postoperative Urinary Retention Following Total Joint...

Area of Science:

• Urology
• Orthopedic Surgery
• Patient Safety

Background:

• Postoperative urinary retention (POUR) is a frequent complication following total joint arthroplasty (TJA).
• Overdiagnosis of POUR via bladder scans can result in unnecessary interventions and complications.
• Current practices may lead to the overdiagnosis of POUR in TJA patients.

Purpose of the Study:

• To evaluate a selective bladder scanning protocol for reducing POUR overdiagnosis.
• To assess the viability of a symptom-guided approach to bladder scanning post-TJA.

Main Methods:

• A comparative study involving 1000 TJA patients (500 standard protocol, 500 selective protocol).
• The selective protocol involved bladder scanning only for patients with urinary retention symptoms.
• Primary outcome was the catheterization rate, analyzed using Chi-squared and Student t-tests.

Main Results:

• Catheterization rates were significantly lower with the selective protocol (38.2%) compared to the standard protocol (46.6%).
• Prevoid bladder volumes were higher in the selective group, indicating less overestimation of retention.
• Key patient and surgical characteristics, as well as outcomes like readmission rates, were similar between groups.

Conclusions:

• The selective bladder scanning protocol effectively reduced catheterization rates in TJA patients.
• This reduction was achieved safely, without increasing urinary-related complications.
• A selective protocol is a viable alternative for minimizing POUR overdiagnosis in TJA.