title: Impact of a bladder scan protocol on discharge efficiency within a care pathway for ambulatory inguinal herniorraphy.
abstract: BACKGROUND
  Postoperative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, with an incidence reaching 38%, and many surgeons require patients to void before discharge. This study aimed to assess whether the implementation of a bladder scan-based voiding protocol reduces the time until discharge after ambulatory inguinal herniorraphy without increasing the rate of POUR.
  
  
  METHODS
  As part of a perioperative care pathway, a protocol was implemented to standardize decision making after elective inguinal hernia repair (February 2012). Patients were assessed with a bladder scan, and those with <600 mL of urine were discharged home, whereas those with more than 600 mL of urine had an in-and-out catheterization before discharge. The patients received written information about urinary symptoms and instructions to present to the emergency department if they were unable to void at home. An audit of scheduled outpatient inguinal hernia repairs between October 2011 and July 2012 was performed. Comparisons were made using the t test, Fisher's exact test, and Wilcoxon rank sum test where appropriate. Statistical significance was defined a priori as a p value lower than 0.05.
  
  
  RESULTS
  During the study period, 124 patients underwent hernia repair: 60 before and 64 after implementation of the protocol. The findings showed no significant differences in patient characteristics, laparoscopic approach (35 vs. 33%; p = 0.80), proportion receiving general anesthesia (70 vs. 73%; p = 0.67), or amount of intravenous fluids given (793 vs. 663 mL; p = 0.07). The proportion of patients voiding before discharge was higher after protocol implementation (73 vs. 89%; p = 0.02). The protocol had no impact on median time to discharge (190 vs. 205 min; p = 0.60). Only one patient in each group presented to the emergency department with POUR (2%).
  
  
  CONCLUSIONS
  After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge. The incidence of POUR was lower than reported in the literature.
authors: Division of General Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada, ioana.antonescu@mail.mcgill.ca.
authors: I
authors: I
authors: Antonescu
authors: G
authors: G
authors: Baldini
authors: D
authors: D
authors: Watson
authors: P
authors: P
authors: Kaneva
authors: G M
authors: GM
authors: Fried
authors: K
authors: K
authors: Khwaja
authors: M C
authors: MC
authors: Vassiliou
authors: F
authors: F
authors: Carli
authors: L S
authors: LS
authors: Feldman
mesh_terms: D000556:Ambulatory Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000473:pathology; D014546:Urinary Catheterization / Q000379:methods*; D016055:Urinary Retention / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
references: Surg Endosc. 2002 Nov;16(11):1547-50
references: 12042905
references: Reg Anesth Pain Med. 2002 Nov-Dec;27(6):612-7
references: 12430114
references: World J Surg. 2005 Aug;29(8):1058-61
references: 15981039
references: Anesthesiol Clin. 2009 Sep;27(3):465-84, table of contents
references: 19825487
references: ANZ J Surg. 2004 Aug;74(8):658-61
references: 15315566
references: JSLS. 2006 Oct-Dec;10(4):457-60
references: 17575757
references: Rev Esp Anestesiol Reanim. 2012 Jan;59(1):18-24
references: 22429632
references: AANA J. 2002 Dec;70(6):441-7
references: 12526149
references: Eur J Anaesthesiol. 2011 Mar;28(3):190-4
references: 21206278
references: Korean J Urol. 2012 Jun;53(6):419-23
references: 22741052
references: Br J Surg. 2012 Feb;99(2):168-85
references: 21928388
references: Acta Anaesthesiol Scand. 2008 Feb;52(2):169-74
references: 17999709
references: Anesthesiology. 2002 Aug;97(2):315-9
references: 12151918
references: Int Anesthesiol Clin. 2012 Winter;50(1):101-10
references: 22227426
references: Can J Anaesth. 2012 Jul;59(7):681-703
references: 22535232
references: Anesth Analg. 1999 Jul;89(1):90-7
references: 10389784
references: Anesth Analg. 1998 Oct;87(4):816-26
references: 9768776
references: Anesthesiology. 2009 May;110(5):1139-57
references: 19352147
references: Korean J Anesthesiol. 2013 May;64(5):414-9
references: 23741563
references: Anesth Analg. 2004 Mar;98(3):632-41, table of contents
references: 14980911
references: Anesthesiology. 1999 Jul;91(1):42-50
references: 10422927
references: J Surg Res. 2000 Jan;88(1):13-7
references: 10644460
references: Anesthesiol Clin North Am. 2003 Jun;21(2):263-72
references: 12812394
references: Am Surg. 1991 Aug;57(8):486-8; discussion 488-9
references: 1928990