Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway

Autor: Nicolas Demartines, Josep Solà, Martin Hübner, Juliette Slieker, Fabian Grass, Pierre Frauche, Catherine Blanc
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Databases
Factual
Visual analogue scale
Urinary system
030230 surgery
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Risk Factors
Internal medicine
medicine
Humans
Colectomy
Aged
Retrospective Studies
Postoperative Care
business.industry
Urinary retention
Incidence
Acute kidney injury
Rectum
Odds ratio
Middle Aged
Urinary Retention
medicine.disease
Colorectal surgery
Surgery
Critical Pathways
Female
Logistic Models
Postoperative Care/methods
Postoperative Care/standards
Postoperative Complications/epidemiology
Postoperative Complications/prevention & control
Rectum/surgery
Treatment Outcome
Urinary Retention/epidemiology
Urinary Retention/etiology
Urinary Retention/prevention & control
Colorectal
Enhanced recovery
Fast track
030220 oncology & carcinogenesis
Cohort
medicine.symptom
business
Zdroj: The Journal of surgical research, vol. 207, pp. 70-76
ISSN: 1095-8673
Popis: Background 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). Methods 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. Results 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). Conclusions Male gender and EDA were independent risk factors for postoperative UR which appeared to be a significant impediment for functional recovery.
Databáze: OpenAIRE
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