Development of post-operative urinary retention (POUR) in pediatric patients undergoing orthopedic surgery

Pediatric patients who are unable to void after orthopedic surgery can develop post-operative urinary retention (POUR). The aims of this study were to identify variables that contributed to POUR by comparing characteristics of children who did and did not require urinary intervention and to identify which variables predict patients who are at risk for POUR.

This retrospective chart review evaluated 73 pediatric patients who developed POUR after an orthopedic procedure and matched their characteristics to 73 pediatric patients who did not develop POUR. Multiple levels of analysis were performed to compare variables between groups.

Groups were similar regarding patient characteristics of pre-op mobility, the presence of a neurological disorder, and the placement of an indwelling catheter (IUC) during surgery. The POUR group was had greater immobility after surgery (p < .001); received significantly more opioid (p < .001) for a longer period of time (p < .001). Conditional logistic regression identified post-operative immobility, opioid consumption, duration of opioid exposure, and the presence of patient-controlled analgesia (PCA) as predictors of POUR development.

Nurses caring for pediatric patients following orthopedic surgery can assess for predictive factors and can plan for proactive bladder scanning to aid in early detection of POUR. This study adds to the literature by identifying comonalities in pediatric patients developing POUR after orthopedic surgery.

Consideration should be given to assessing bladder fullness, establishing mobility, and reducing opioid need before removing the IUC or delaying the removal of the IUC for a short time.