Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway.

Details

Serval ID
serval:BIB_6D50EBC3AEF0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway.
Journal
The Journal of surgical research
Author(s)
Grass F., Slieker J., Frauche P., Solà J., Blanc C., Demartines N., Hübner M.
ISSN
1095-8673 (Electronic)
ISSN-L
0022-4804
Publication state
Published
Issued date
01/2017
Peer-reviewed
Oui
Volume
207
Pages
70-76
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Enhanced recovery after surgery (ERAS) guidelines for colorectal surgery suggest routine transurethral bladder drainage with early removal to prevent urinary tract infection (UTI). The aim of this study was to identify risk factors for urinary retention (UR).
This retrospective analysis included all colorectal patients since ERAS implementation in May 2011-November 2014. From the prospective ERAS database, over 100 items related to demographics, surgery, compliance, and outcome were analyzed. Risk factors for UR were identified by multiple logistic regressions; then, UR was correlated to functional outcomes and UTI and acute kidney injury rates.
The study cohort consisted of 513 consecutive patients. Of these, 73 patients (14%) presented with UR. Multivariate analysis identified male gender (odds ratio 1.4; 95% CI, 1-1.8; P = 0.045) and postoperative thoracic epidural analgesia (EDA; odds ratio 2.6; 95% CI, 1.6-4.3; P ≤ 0.001) as independent risk factors for postoperative UR. Functional recovery was impeded in patients with UR, who were less mobile (mobilization day 1 >4 h: 57% versus 70%, P = 0.024) and gained more weight (2.8 ± 2.5 kg versus 1.6 ±3 kg on day 1, P = 0.001) due to fluid overload. Furthermore, patients with urinary catheters reported more pain (visual analog scales day 3: 3.1 ± 2.5 versus 2.2 ± 2.4, P = 0.002) and depended longer on intravenous fluid administration (termination of intravenous fluids later than day 1: 53% versus 39%, P = 0.021). Ten of 73 patients (14%) developed UTI in patients with UR and 42 of 440 (10%) in patients without UR (P = 0.276). Six of 73 patients (8%) developed acute kidney injury in patients with UR and 36 of 440 (8%) in patients without UR (P = 0.991).
Male gender and EDA were independent risk factors for postoperative UR which appeared to be a significant impediment for functional recovery.

Keywords
Adult, Aged, Colectomy, Critical Pathways, Databases, Factual, Female, Humans, Incidence, Logistic Models, Male, Middle Aged, Postoperative Care/methods, Postoperative Care/standards, Postoperative Complications/epidemiology, Postoperative Complications/prevention & control, Rectum/surgery, Retrospective Studies, Risk Factors, Treatment Outcome, Urinary Retention/epidemiology, Urinary Retention/etiology, Urinary Retention/prevention & control, Colorectal, Enhanced recovery, Fast track, Urinary retention
Pubmed
Web of science
Create date
29/12/2016 13:37
Last modification date
20/08/2019 14:26
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