Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway

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• 作者：Fabian Grass ; MD^a ; Juliette Slieker ; MD^a ; Pierre Frauche ; MD^a ; Josep Solà ; PhD^b ; Catherine Blanc ; MD^c ; Nicolas Demartines ; MD^a ; ^{demartines@chuv.ch} ; Martin Hü ; bner ; MD^a
• 关键词：Enhanced recovery ; Fast track ; Colorectal ; Urinary retention
• 刊名：Journal of Surgical Research
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：207
• 期：Complete
• 页码：70-76
• 全文大小：586 K
• 卷排序：207

文摘

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).MethodsThis 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.ResultsThe 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).ConclusionsMale gender and EDA were independent risk factors for postoperative UR which appeared to be a significant impediment for functional recovery.