D. F. Roadman1, M. Helm1, M. Goldblatt1, T. Kindel1, J. Gould1, R. Higgins1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: Postoperative urinary retention (POUR) can significantly impact quality outcomes, leading to urinary tract infections, longer lengths of stay, and increased healthcare costs. The incidence of POUR in bariatric patients has limited information in the literature. The primary objective of this study was to determine the incidence of and risk factors contributing to POUR in primary bariatric surgery patients.
Methods: A retrospective chart review was performed of patients who underwent a laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) at a single institution from 2013 to 2017. POUR was defined as the inability to urinate postoperatively requiring urinary straight or indwelling catheterization prior to discharge. Univariate analyses were performed on perioperative variables and their correlation with POUR.
Results: In total, 603 patients underwent primary bariatric surgery during the study period: 317 (52.6%) LSG and 286 (47.4%) LRYGB. Overall, 49 (8.1%) patients developed POUR with a mean volume at time of urinary catheter intervention of 682.5 ± 319.7 mL. There were no significant differences in pre-operative demographics between patients with and without POUR. Patients who underwent a LSG had an increased incidence of POUR at 11.4% compared to 4.5% after LRYGB (p=0.002). Additionally, POUR was significantly associated with decreased neostigmine usage, isolated non-depolarizing muscle relaxant usage, and reduced intraoperative fluid administration (Table 1). Female patients with POUR had a significantly longer length of stay at 2.14 ± 1.17 days compared to those without POUR at 1.71 ± 1.25 days (p=0.046). There was no significant difference in length of stay for male patients.
Conclusion: Risk factors associated with POUR after primary bariatric surgery include LSG, less intraoperative neostigmine and intravenous fluids, as well as isolated non-depolarizing muscle relaxants. Female patients who developed POUR had a longer length of stay. These risk factors can be used to educate patients, as well as identify quality initiatives that focus on perioperative and anesthetic management. Creating a standardized protocol for the management of urinary retention in these patients could also impact its effect on length of stay.
