title: Urinary Retention is Rare After Total Joint Arthroplasty When Using Opioid-Free Regional Anesthesia.
abstract: BACKGROUND
  Postoperative urinary retention (POUR) is a relatively common complication after total joint arthroplasty (TJA). Based on the findings of a randomized, prospective study from our institution, we abandoned the routine use of indwelling urinary catheters in patients undergoing elective TJA using opioid-free spinal anesthesia. The aim of this study was to determine the incidence of and the risk factors for POUR in this patient population.
  
  
  METHODS
  A total of 842 consecutive patients underwent TJA between January 2012 and September 2014 using opioid-free spinal anesthesia in whom indwelling urinary catheters were not used. Postoperative urinary retention was defined as the inability of a patient to void that necessitated the placement of either an indwelling urinary catheter or straight catheterization. Multivariate logistic regression analysis was used to determine risk factors for developing POUR.
  
  
  RESULTS
  In this cohort, 79 patients (79/842; 9.3%) developed POUR. Independent risk factors for POUR were history of a benign prostatic hyperplasia (P = .02), renal disease (P = .001), longer operative time (P = .003), and age older than 67 years (P = .02). No patients in this cohort developed neurogenic bladder.
  
  
  CONCLUSIONS
  This study confirms that the routine use of indwelling urinary catheters for patients undergoing TJA using an opioid-free spinal anesthesia may not be warranted. Urinary catheters may be used selectively in patients at risk for subsequent urinary retention.
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Tischler
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Camilo
authors.initials: C
authors.lastname: Restrepo
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Oh
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Matthews
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.affiliation: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: research@rothmaninstitute.com.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D000075202:Contraindications; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid
keywords: opioid-free; regional anesthesia; spinal anesthesia; total joint arthroplasty; urinary retention