Incidence and Risk Factors for Postoperative Urinary Retention in Total Hip Arthroplasty Performed Under Spinal Anesthesia.
BACKGROUND
The objective of this study is to determine the risk factors for postoperative urinary retention (POUR) following total hip arthroplasty (THA) under spinal anesthesia.


METHODS
Consecutive patients who underwent a primary THA without preoperative catheterization under spinal anesthesia were identified in a prospectively collected institutional patient database. All patients were monitored postoperatively for urinary retention on the basis of symptoms and the use of bladder ultrasound scans performed by a hospital technician. If necessary, straight catheterization was performed up to 2 times prior to indwelling catheter insertion.


RESULTS
One hundred eighty patients were included in the study. Six patients who required indwelling catheterization for intraoperative monitoring were excluded. Seventy-six patients experienced POUR and required straight catheterization. Fourteen patients ultimately required indwelling catheterization. One patient who was not catheterized developed a urinary tract infection versus none of the patients who were catheterized. POUR was significantly associated with intraoperative fluid volume and a history of urinary retention (P = .018 and .023, respectively). Intraoperative fluid volumes of 2025, 2325, 2875, and 3800 mL were associated with a specificity for POUR of 60%, 82.7%, 94.9%, and 98%, respectively. No significant associations were found among catheterization and gender, body mass index, American Society of Anesthesiologists class, history of polyuria, history of incontinence, postoperative oral narcotics use, or surgical duration.


CONCLUSION
Patients with a history of prior urinary retention and those who receive high volumes of intraoperative fluid volume are at higher risk for POUR following THA performed under spinal anesthesia.
['Lawrie|Charles M|CM|', 'Ong|Alvin C|AC|', 'Hernandez|Victor H|VH|', 'Rosas|Samuel|S|', 'Post|Zachary D|ZD|', 'Orozco|Fabio R|FR|']
D000328:Adult D000368:Aged D000775:Anesthesia, Spinal D019644:Arthroplasty, Replacement, Hip D015992:Body Mass Index D002404:Catheterization D005260:Female D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D016343:Monitoring, Intraoperative D059035:Perioperative Period D011183:Postoperative Complications D011184:Postoperative Period D011446:Prospective Studies D012307:Risk Factors D014546:Urinary Catheterization D016055:Urinary Retention D014552:Urinary Tract Infections
urinary retention hip arthroplasty spinal anesthesia bladder management postoperative complications safety