Risk factors for postoperative indwelling catheter following enhanced recovery after total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Han ¹ , CAO Guorui ² ,  PEI Fuxing ² ,  SONG Bin ³

1. Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
3. Department of Radiology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

PEI Fuxing, Email: peifuxinghuaxi@126.com; SONG Bin, Email: cjr.songbin@vip.163.com

Keywords：

Total knee arthroplasty; indwelling catheter; risk factor; enhanced recovery

DOI：

10.7507/1002-1892.201906126

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Objective To evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.Methods Patients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.Results Indwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).Conclusion The male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.

Citation： YANG Han, CAO Guorui, PEI Fuxing, SONG Bin. Risk factors for postoperative indwelling catheter following enhanced recovery after total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 357-361. doi: 10.7507/1002-1892.201906126 Copy

1.	Cao G, Xie J, Huang Z, et al. Efficacy and safety of multiple boluses of oral versus intravenous tranexamic acid at reducing blood loss after primary total knee arthroplasty without a tourniquet: A prospective randomized clinical trial. Thromb Res, 2018, 171: 68-73.
2.	Dailly S. Prevention of indwelling catheter-associated urinary tract infections. Nurs Older People, 2011, 23(2): 14-19.
3.	Oishi CS, Williams VJ, Hanson PB, et al. Perioperative bladder management after primary total hip arthroplasty. J Arthroplasty, 1995, 10(6): 732-736.
4.	Karason S, Olafsson TA. Avoiding bladder catheterisation in total knee arthroplasty: patient selection criteria and low-dose spinal anaesthesia. Acta Anaesthesiol Scand, 2013, 57(5): 639-645.
5.	雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.
6.	Huang Z, Ma J, Shen B, et al. General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty. J Arthroplasty, 2015, 30(3): 502-506.
7.	陈有荣, 文鹏飞, 郭万首, 等. 初次髋膝关节置换术中不留置尿管的可行性和安全性研究. 中华关节外科杂志 (电子版), 2018, 12(3): 350-355.
8.	罗秋平, 王娟, 杨静. 非止血带下初次单侧全膝关节置换术前不留置尿管的安全性及可行性评价. 华西医学, 2017, 32(7): 1060-1063.
9.	周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
10.	周宗科, 翁习生, 向兵, 等. 中国髋、膝关节置换术加速康复——围术期贫血诊治专家共识. 中华骨与关节外科杂志, 2016, 9(1): 10-15.
11.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
12.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
13.	Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
14.	Macdowell AD, Robinson AH, Hill DJ, et al. Is epidural anaesthesia acceptable at total hip arthroplasty? A study of the rates of urinary catheterisation. J Bone Joint Surg (Br), 2004, 86(8): 1115-1117.
15.	Miller AG, McKenzie J, Greenky M, et al. Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(16): 1498-1503.
16.	张少云, 黄强, 曹国瑞, 等. 加速康复外科模式下全膝关节置换术围术期限制性输液的临床研究. 中国矫形外科杂志, 2017, 25(17): 1567-1571.
17.	Cao G, Huang Q, Xu B, et al. Multimodal nutritional management in primary total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2017, 32(11): 3390-3395.
18.	Davis S, Erskine R, James MF. A comparison of spinal and epidural anaesthesia for hip arthroplasty. Can J Anaesth, 1992, 39(6): 551-554.
19.	Griesdale DE, Neufeld J, Dhillon D, et al. Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth, 2011, 58(12): 1097-1104.

1. Cao G, Xie J, Huang Z, et al. Efficacy and safety of multiple boluses of oral versus intravenous tranexamic acid at reducing blood loss after primary total knee arthroplasty without a tourniquet: A prospective randomized clinical trial. Thromb Res, 2018, 171: 68-73.
2. Dailly S. Prevention of indwelling catheter-associated urinary tract infections. Nurs Older People, 2011, 23(2): 14-19.
3. Oishi CS, Williams VJ, Hanson PB, et al. Perioperative bladder management after primary total hip arthroplasty. J Arthroplasty, 1995, 10(6): 732-736.
4. Karason S, Olafsson TA. Avoiding bladder catheterisation in total knee arthroplasty: patient selection criteria and low-dose spinal anaesthesia. Acta Anaesthesiol Scand, 2013, 57(5): 639-645.
5. 雷一霆, 黄强, 张少云, 等. 人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究. 中国修复重建外科杂志, 2017, 31(11): 1295-1299.
6. Huang Z, Ma J, Shen B, et al. General anesthesia: to catheterize or not? A prospective randomized controlled study of patients undergoing total knee arthroplasty. J Arthroplasty, 2015, 30(3): 502-506.
7. 陈有荣, 文鹏飞, 郭万首, 等. 初次髋膝关节置换术中不留置尿管的可行性和安全性研究. 中华关节外科杂志 (电子版), 2018, 12(3): 350-355.
8. 罗秋平, 王娟, 杨静. 非止血带下初次单侧全膝关节置换术前不留置尿管的安全性及可行性评价. 华西医学, 2017, 32(7): 1060-1063.
9. 周宗科, 翁习生, 曲铁兵, 等. 中国髋、膝关节置换术加速康复——围术期管理策略专家共识. 中华骨与关节外科杂志, 2016, 9(1): 1-9.
10. 周宗科, 翁习生, 向兵, 等. 中国髋、膝关节置换术加速康复——围术期贫血诊治专家共识. 中华骨与关节外科杂志, 2016, 9(1): 10-15.
11. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
12. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
13. Balderi T, Mistraletti G, D’Angelo E, et al. Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization. Minerva Anestesiol, 2011, 77(11): 1050-1057.
14. Macdowell AD, Robinson AH, Hill DJ, et al. Is epidural anaesthesia acceptable at total hip arthroplasty? A study of the rates of urinary catheterisation. J Bone Joint Surg (Br), 2004, 86(8): 1115-1117.
15. Miller AG, McKenzie J, Greenky M, et al. Spinal anesthesia: should everyone receive a urinary catheter?: a randomized, prospective study of patients undergoing total hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(16): 1498-1503.
16. 张少云, 黄强, 曹国瑞, 等. 加速康复外科模式下全膝关节置换术围术期限制性输液的临床研究. 中国矫形外科杂志, 2017, 25(17): 1567-1571.
17. Cao G, Huang Q, Xu B, et al. Multimodal nutritional management in primary total knee arthroplasty: a randomized controlled trial. J Arthroplasty, 2017, 32(11): 3390-3395.
18. Davis S, Erskine R, James MF. A comparison of spinal and epidural anaesthesia for hip arthroplasty. Can J Anaesth, 1992, 39(6): 551-554.
19. Griesdale DE, Neufeld J, Dhillon D, et al. Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth, 2011, 58(12): 1097-1104.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors for postoperative indwelling catheter following enhanced recovery after total knee arthroplasty

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