Yoeri Bemelmans

Chapter 5 66 None of the patients underwent re-catheterization after treatment of POUR. Median bladder volume at the recovery room for the total group was 200 ml. When using this as a cutoff value, bladder volume of >200 ml at the recovery room was a risk factor for POUR (OR 5.049, 95% CI 2.815–9.054) (Table 3). Table 3. Pre- and postoperative bladder volume outcomes are presented as mean (SD) with p-value. Pour (n=82) Non-Pour (n=556) P-value Preoperative Preoperative bladder volume in ml, (SD) 47.78 (61.69) 37.99 (53.68) 0.131 Postoperative Bladder volume at recovery room in ml, mean (SD) 468.21 (257.67) 215.47 (139.59) 0.000 Discussion The most important finding of the present study was that with the use of a nurse-led bladder scan protocol combined with pre-, peri-, and postoperative optimisations (e.g., fluid restriction, opioid-sparing pain protocol), the incidence of POUR after arthroplasty patients following a fast-track pathway was 12.9%, with >200 ml of bladder volume at the recovery room as a risk factor for POUR. The first large-scale and multicenter prospective study on POUR after arthroplasty showed an incidence of approximately 40% [5]. Later series found an incidence of 13–32% depending on the used cutoff value for bladder volume, respectively, 800 and 500 ml [6]. Balderi et al. [2] reported an incidence of 25% in arthroplasty patients and concluded that the use of a bladder scan algorithm can reduce the incidence of POUR. An even lower incidence of POUR after hip and knee arthroplasty was found by Tischler et al. [27]. They performed only bladder scans on patients with symptomatic bladder distention and could therefore underrate the incidence of POUR. Compared to these studies, the presented incidence of POUR in this study was low. A possible explanation for the low incidence of POUR could be the selection prior to surgery. Since it is known that a preoperative bladder volume of >270 ml is a risk factor for POUR [3], the present study created a safe cutoff value for preoperative urinary retention (>250 ml) and excluded these patients from analysis. In case of preoperative urinary retention, patients were treatedwith indwelling catheterization prior to surgery [29]. Another explanation could be the wide range of bladder volume as cutoff values (400–800 ml) in the literature [2, 5, 6, 29]. These cutoff values can affect a valid comparison between the study results. Frequent monitoring with the use of a bladder scan decreases the incidence of POUR [8, 9, 18] and should be performed 6–8 h after the start of anesthesia [15]. In the current study, monitoring continued directly postoperative at the recovery room and was repeated every 3 h at