title: Acute urinary retention after cesarean delivery: a case-control study.
abstract: BACKGROUND
  This study aimed to identify risk factors for postpartum urinary retention (PPUR) after cesarean delivery (CD).
  
  
  METHODS
  A case-control study design was used. Cases of PPUR after CD were identified using billing codes for CD and "urinary retention" and confirmed by chart review. Matched controls were identified in a 2:1 ratio using an obstetrics database and billing data. Patient demographics, operative, and anesthetic data were collected. Fisher exact tests and Wilcoxon rank sum tests were used to determine differences in medical risk factors, postoperative analgesic use, and catheter management between cases and controls. A modified Poisson conditional multivariate regression with robust error variances was used to estimate the odds ratios (ORs) for significant predictors.
  
  
  RESULTS
  Thirty-four confirmed cases of PPUR were matched with 68 controls. The mean ages of cases and controls were 31 and 32 years, respectively. Cases and controls differed in gestational age (P = 0.01), diagnosis of diabetes (P = 0.05), and use of postoperative intravenous and oral narcotics (P < 0.01 and P = 0.03, respectively). In a multivariate model including these factors, increasing gestational age was associated with decreased risk of PPUR [OR, 0.07; 95% confidence interval (CI), 0.01-0.48; P < 0.01], whereas use of postoperative intravenous narcotics (OR, 4.51; 95% CI, 1.09-18.67; P = 0.038) and oral narcotics (OR, 4.99; 95% CI, 1.10-22.65; P = 0.037) were associated with increased risk.
  
  
  CONCLUSIONS
  After matching for obstetric factors, use of postoperative narcotic analgesia was associated with increased risk of PPUR. Other operative and anesthetic factors had no association. Multicenter prospective studies are needed to investigate this association.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA; and †Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Padma
authors.initials: P
authors.lastname: Kandadai
authors.forename: Venk
authors.initials: V
authors.lastname: Kandadai
authors.forename: Jyot
authors.initials: J
authors.lastname: Saini
authors.forename: Katharine
authors.initials: K
authors.lastname: O'Dell
authors.forename: Danielle
authors.initials: D
authors.lastname: Patterson
authors.forename: Michael K
authors.initials: MK
authors.lastname: Flynn
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D008875:Middle Aged; D049590:Postpartum Period; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid