T. C. Friske1, R. Sola3, Y. R. Yu1,2, A. R. Jamal1, E. Rosenfeld1,2, H. Zhu2, S. D. St. Peter3, S. R. Shah1,2 1Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 2Texas Children’s Hospital,Division Of Pediatric Surgery,Houston, TX, USA 3Children’s Mercy Hospital,Division Of Pediatric Surgery,Kansas City, MO, USA
Introduction: High narcotic requirements after minimally invasive repair of pectus excavatum (MIRPE) can increase the risk of urinary retention. Intraoperative Foley catheters are often placed to minimize the risk of this complication; however, there is variation in this practice. The objective of this study is to determine the urinary retention rate in this population to guide future practice.
Methods: A retrospective review was performed of all patients that underwent MIRPE from 1/2012–7/2016 at two academic children’s hospitals. Data collected included patient demographics, body mass index (BMI), severity of pectus defect [Haller Index (HI)], postoperative pain management, and incidence of urinary retention and urinary tract infections (UTI). Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley. Statistical analysis was performed using the Wilcoxon rank test, Fisher’s exact test, and univariate and multivariable logistic regression analyses to identify risk factors for urinary retention.
Results:A total of 305 patients (mean age 15.9 ± 2.6 years) underwent MIRPE (205 at Hospital 1 and 100 at Hospital 2). An intraoperative Foley was placed in 84 (41%) patients at Hospital 1, and 80 (80%) patients at Hospital 2 (p<0.0001). Overall, mean HI was 4.4 ± 1.5 and there were 257 (84%) males. The mean IV morphine equivalents received was 1.4 ± 1.2 mg/kg/day per patient with a mean hospital length of stay of 4.7 ± 1.1 days. There were 195 (64%) patients who exclusively had patient-controlled analgesia (PCA), 95 (31%) exclusively had an epidural, and 15 (5%) had both for postoperative pain management. An intraoperative Foley was placed in 164 (54%) patients. Gender, BMI, and HI were not factors in determining Foley placement. However, patients with epidurals were more likely to have an intraoperative Foley (OR 2.1, 95% CI 1.3–3.5, p<0.01). There were no UTIs in the entire population. The urinary retention rate was 38% (n=53) for patients without an intraoperative Foley, and 1.8% (n=3) in patients after removal of intraoperatively placed Foley (p<0.0001). Adjusting for age, gender, BMI, HI, and pain control regimen, the only significant risk factor for urinary retention in patients without an intraoperatively placed Foley was having an epidural (OR 2.8, 95% CI 1.2–6.4, p=0.02); however, patients on a PCA without an intraoperatively placed Foley still had a urinary retention rate of 32%.
Conclusion:Intraoperative Foley catheters obviate urinary retention without increasing the risk of urinary tract infection following minimally invasive repair of pectus excavatum. Based on high rate of retention in those managed without an intraoperative Foley, we suggest surgeons discuss these findings with patients and families to determine the preference for Foley catheter placement during minimally invasive repair of pectus excavatum.