Objective To systematically review the incidence and risk factors of postoperative urinary retention (POUR) in patients undergoing hip or knee arthroplasty, and provide a theoretical basis for medical staff to assess and identify high-risk groups in advance. Methods PubMed, Embase, the Cochrane Library, Medline, China National Knowledge Infrastructure, Wanfang Data, VIP database, and SinoMed were electronically searched from the establishment of the databases to January 2023, for literature on the incidence and risk factors of POUR in patients undergoing hip or knee arthroplasty. Two researchers independently screened studies, extracted data, and assessed study quality. Meta-analysis was performed using Stata 14.0 software. Results A total of 21 articles were included, including 9041 patients undergoing hip or knee arthroplasty. The results of meta-analysis showed that the incidence of POUR in patients undergoing hip or knee arthroplasty was 26% [95% confidence interval (CI) (19%, 32%)]. Age [odds ratio (OR)=1.03, 95%CI (1.00, 1.05), P=0.03], male [OR=2.68, 95%CI (1.72, 4.18), P<0.001], infusion volume [OR=2.17, 95%CI (1.08, 4.35), P=0.030], spinal anesthesia [OR=1.72, 95%CI (1.29, 2.30), P<0.001], history of urinary retention/urethral stricture [OR=1.84, 95%CI (1.35, 2.49), P<0.001], use of analgesic pump [OR=4.73, 95%CI (2.29, 9.78), P<0.001], use of glycopyrronium bromide [OR=2.79, 95%CI (1.53, 5.11), P=0.001] were risk factors for POUR in patients undergoing hip or knee arthroplasty. Conclusions The incidence of POUR in patients undergoing hip or knee arthroplasty is relatively high. Age, male, infusion volume, spinal anesthesia, history of urinary retention/urethral stenosis, use of analgesia pump, and use of glycopyrronium bromide are causes of POUR. It is suggested that medical staff should identify the risk of related factors and take early intervention to reduce the occurrence of POUR.
ObjectiveTo analyze the urinary catheter indwelling duration and its associated clinical outcomes in patients undergoing hepatobiliary and pancreatic surgery, so as to provide evidence for promoting early catheter removal practices and optimizing urinary catheter clinical management. MethodsThe data were retrospectively collected from patients who underwent surgery and had an indwelling urinary catheter in the Departments of Liver Surgery, Biliary Tract Surgery, and Pancreatic Surgery at West China Hospital of Sichuan University from January 1, 2023 to December 31, 2023. Multivariate logistic regression was used to analyze the risk factors for urinary retention and catheter-associated urinary tract infection (CAUTI) after urinary catheter removal, and multiple linear regression was used to analyze the factors influencing postoperative hospital stay. ResultsA total of 3 840 patients with indwelling urinary catheters were included, among whom the postoperative urinary catheter indwelling duration was <24 h (defined as early urinary catheter removal), 24–48 h, 49–72 h, and ≥72 h in 1 243 (32.4%), 1 678 (43.7%), 572 (14.9%), and 347 (9.0%) patients, respectively. The highest rate of early urinary catheter removal was observed in patients undergoing biliary tract surgery [52.1% (164/315)], and the lowest rate was observed in those undergoing pancreatic surgery [9.6% (102/1 064)]. Among the 3 840 patients with indwelling urinary catheter, urinary retention occurred in 213 (5.5%), CAUTI in 64 (1.7%), and urinary catheter reinsertion in 202 (5.3%). Multivariate logistic regression analysis showed that the risk of urinary retention was higher after pancreatic surgery and liver surgery compared with biliary tract surgery (OR=3.869, P=0.001; OR=2.425, P=0.017, respectively), and the risk was also higher in patients with operative time ≥180 min than in those with operative time <180 min (OR=1.537, P=0.003). Patients with urinary catheter indwelling duraion of 24–48 h, 49–72 h, or ≥72 h had a lower risk of urinary retention compared with those with early urinary catheter removal (OR=0.398, P<0.001; OR=0.177, P<0.001; OR=0.452, P=0.003, respectively). Independent risk factors for CAUTI after catheter removal were identified as urinary catheter reinsertion (adjusted OR=7.643, P<0.001), age 65–74 years and ≥75 years (using <45 years as reference; adjusted OR=4.708 and 7.201, P=0.006 and 0.002, respectively), female (adjusted OR=1.972, P=0.009), operative time ≥180 min (adjusted OR=2.317, P=0.003), and urinary catheter indwelling duration of 24–48 h, 49–72 h, and ≥72 h (using <24 h as reference; adjusted OR=3.328, 4.196, and 20.794; P=0.018, 0.013, and <0.001, respectively). Urinary catheter reinsertion, pancreatic surgery (using biliary tract surgery as reference), operative time ≥180 min, and prolonged urinary catheter indwelling duration (24–48 h, 49–72 h, and ≥72 h compared with <24 h) were associated with prolonged mean postoperative hospital stay (unstandardized coefficients were 2.089, 1.024, 1.536, 0.820, 0.878, and 1.244, respectively; all P<0.001). ConclusionsPostoperative urinary catheter indwelling duration in patients undergoing hepatobiliary and pancreatic surgery differs from guideline recommendations, and early removal might increase the risk of urinary retention. Early catheter removal should be implemented clinically while minimizing the risk of urinary retention.