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Bladder management in patients undergoing spine surgery: An assessment of care delivery

BACKGROUND: Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated...

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Autores principales: Leitner, Lorenz, Wanivenhaus, Florian, Bachmann, Lucas M., Liechti, Martina D., Aguirre, José A., Farshad, Mazda, Kessler, Thomas M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820009/
https://www.ncbi.nlm.nih.gov/pubmed/35141624
http://dx.doi.org/10.1016/j.xnsj.2021.100059
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author Leitner, Lorenz
Wanivenhaus, Florian
Bachmann, Lucas M.
Liechti, Martina D.
Aguirre, José A.
Farshad, Mazda
Kessler, Thomas M.
author_facet Leitner, Lorenz
Wanivenhaus, Florian
Bachmann, Lucas M.
Liechti, Martina D.
Aguirre, José A.
Farshad, Mazda
Kessler, Thomas M.
author_sort Leitner, Lorenz
collection PubMed
description BACKGROUND: Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. METHODS: Preoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. RESULTS: Hundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p < 0.05). In the 46 preoperatively catheterized patients, re-catheterization was required in 6 (13%). In a fairly homogenous subgroup of 72 patients with a probability of PUC between 15 and 40%, no significant association between intraoperative urethral catheter-free management and the occurrence of PUC was found (odds ratio 2.09, 95% confidence interval 0.69 to 6.33; p = 0.193). CONCLUSIONS: In case of postoperative PVR monitoring allowing de novo catheterization as appropriate, urethral catheter-free management seems to be a valuable option in spine surgery since it does not to increase PUC but minimizes unnecessary catheterizations with their related complications.
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spelling pubmed-88200092022-02-08 Bladder management in patients undergoing spine surgery: An assessment of care delivery Leitner, Lorenz Wanivenhaus, Florian Bachmann, Lucas M. Liechti, Martina D. Aguirre, José A. Farshad, Mazda Kessler, Thomas M. N Am Spine Soc J Clinical Studies BACKGROUND: Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. METHODS: Preoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. RESULTS: Hundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p < 0.05). In the 46 preoperatively catheterized patients, re-catheterization was required in 6 (13%). In a fairly homogenous subgroup of 72 patients with a probability of PUC between 15 and 40%, no significant association between intraoperative urethral catheter-free management and the occurrence of PUC was found (odds ratio 2.09, 95% confidence interval 0.69 to 6.33; p = 0.193). CONCLUSIONS: In case of postoperative PVR monitoring allowing de novo catheterization as appropriate, urethral catheter-free management seems to be a valuable option in spine surgery since it does not to increase PUC but minimizes unnecessary catheterizations with their related complications. Elsevier 2021-04-06 /pmc/articles/PMC8820009/ /pubmed/35141624 http://dx.doi.org/10.1016/j.xnsj.2021.100059 Text en © 2021 The Author(s). Published by Elsevier Ltd on behalf of North American Spine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Studies
Leitner, Lorenz
Wanivenhaus, Florian
Bachmann, Lucas M.
Liechti, Martina D.
Aguirre, José A.
Farshad, Mazda
Kessler, Thomas M.
Bladder management in patients undergoing spine surgery: An assessment of care delivery
title Bladder management in patients undergoing spine surgery: An assessment of care delivery
title_full Bladder management in patients undergoing spine surgery: An assessment of care delivery
title_fullStr Bladder management in patients undergoing spine surgery: An assessment of care delivery
title_full_unstemmed Bladder management in patients undergoing spine surgery: An assessment of care delivery
title_short Bladder management in patients undergoing spine surgery: An assessment of care delivery
title_sort bladder management in patients undergoing spine surgery: an assessment of care delivery
topic Clinical Studies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820009/
https://www.ncbi.nlm.nih.gov/pubmed/35141624
http://dx.doi.org/10.1016/j.xnsj.2021.100059
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