Download - POUR AANS 1226 presentation A. Bashee[1]
The Incidence and Risk Factors for Postoperative Urinary Retention (POUR) in
the Neurosurgical Patients
Azam Basheer MD
Donald Seyfried MD, Senior StaffDepartment of Neurosurgery
Henry Ford Hosital
Detroit, MI
Introduction
• Definition: inability to empty bladder completely 1
• Sequelae 2-7:– Can lead to significant pain, anxiety and longer hospital
stays Bladder distention– Renal failure• Standard treatment:– Straight catheterization: could lead to urethral strictures,
trauma, infection and possibly delirium. 7 – Indwelling catheter re insertion if no improvement
Incidence
• POUR is reported to occur in 5 to 75% of all surgical procedures.1,7,9
• Highest in urologic, colorectal and certain orthopedics procedures
• Multifactorial in nature
POUR in Neurosurgery
• Has not been extensively studied. • Boulis et al. reported a 39.1% incidence in
503 spine patients 10
• Mclain et al reported 23% incidence in 200 lumbar spine patients 11
• Jellish et al, reported 22.9% incidence in 61 lumbar spine patients 12
Study Design
• A cohort of 137 neurosurgical patients were prospectively followed for the development of POUR between 5/2010 – 6/2011
• Definition: Post void residual (PVR) >250 ml 6 hours after the removal of the indwelling urinary catheter (IUC)
• For patients with PVR >250 ml on the third check, IUCs were re-inserted, and kept for 5-7 days.
Results
• The overall incidence of clinical POUR was 39.4%
• Statistical significance (p< 0.05) for high PVR1 was noted in – Males– Patients older than 60 years of age– Spine surgery
PVR1 information by patient characteristics:
0100200300400500
Male Female
Gender (p<0.001)
Me
an
PV
R1
(S
E)
0100200300400500
<60 years 60+ years
Age (p=0.043)
Me
an
PV
R1
(S
E)
0100200300400500
<=200 min >200 min
Surgery Time (p=0.08)
Me
an
PV
R1
(S
E)
0100200300400500
Cranial C/T Lumbar
Surgery location (p=0.012)
Me
an
PV
R1
(S
E)
PVR1 information by patient characteristics:
0100200300400500
Yes No
Diabetes (p=0.10)
Me
an
PV
R1
(S
E)
0100200300400500
Yes No
Beta Blockers (p=0.079)
Me
an
PV
R1
(S
E)
0100200300400500
Yes No
anticholinergic (p=0.634)
Me
an
PV
R1
(S
E)
0100200300400500
<=30 >30
BM I (p=0.265)
Me
an
PV
R1
(S
E)
POUR and Length of Hospital Stay (r=0.176,p=0.04).
Results cont.
• Of all patients, 24 (18%) had IUCs re-inserted postoperatively
• The association of IUC re-insertion with male gender was significant (28%, P=0.001).
• Table 3: Sensitivity, specificity and positive and negative predictive values for IUC re-insertion(actual or intended) by cutpoints of PVR1
PPV
Conclusion
• POUR is prevalent among neurosurgical patients, especially in males, older than 60 years of age, and those with spinal pathologies.
• It leads to high rates of infection, complication, cost, and longer hospital stay.
• Studies are under way to find potential points of intervention that would lead to decreased POUR incidence.
Questions?
Thank you for listeningCredit to:
Dr M. Alsaidi
Dr M. Abdulhak
Dr M. Chedid
Joanne Guiano RN
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10) Boulis NM, Mian FS, Rodriguez D, et al. Urinary retention following routine neurosurgical spine procedures. Surg Neurol 2001;55(1):23–7
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