title: Postoperative urinary retention in colorectal surgery within an enhanced recovery pathway.
abstract: Enhanced recovery after surgery (ERAS) guidelines for colorectal surgery suggest routine transurethral bladder drainage with early removal to prevent urinary tract infection (UTI). The aim of this study was to identify risk factors for urinary retention (UR).
  
  
  
  This retrospective analysis included all colorectal patients since ERAS implementation in May 2011-November 2014. From the prospective ERAS database, over 100 items related to demographics, surgery, compliance, and outcome were analyzed. Risk factors for UR were identified by multiple logistic regressions; then, UR was correlated to functional outcomes and UTI and acute kidney injury rates.
  
  
  
  The study cohort consisted of 513 consecutive patients. Of these, 73 patients (14%) presented with UR. Multivariate analysis identified male gender (odds ratio 1.4; 95% CI, 1-1.8; P = 0.045) and postoperative thoracic epidural analgesia (EDA; odds ratio 2.6; 95% CI, 1.6-4.3; P ≤ 0.001) as independent risk factors for postoperative UR. Functional recovery was impeded in patients with UR, who were less mobile (mobilization day 1 >4 h: 57% versus 70%, P = 0.024) and gained more weight (2.8 ± 2.5 kg versus 1.6 ±3 kg on day 1, P = 0.001) due to fluid overload. Furthermore, patients with urinary catheters reported more pain (visual analog scales day 3: 3.1 ± 2.5 versus 2.2 ± 2.4, P = 0.002) and depended longer on intravenous fluid administration (termination of intravenous fluids later than day 1: 53% versus 39%, P = 0.021). Ten of 73 patients (14%) developed UTI in patients with UR and 42 of 440 (10%) in patients without UR (P = 0.276). Six of 73 patients (8%) developed acute kidney injury in patients with UR and 36 of 440 (8%) in patients without UR (P = 0.991).
  
  
  
  Male gender and EDA were independent risk factors for postoperative UR which appeared to be a significant impediment for functional recovery.
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Grass
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Juliette
authors.initials: J
authors.lastname: Slieker
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frauche
authors.affiliation: Centre Suisse d'Electronique et de Microtechnique CSEM, Neuchâtel, Switzerland.
authors.forename: Josep
authors.initials: J
authors.lastname: Solà
authors.affiliation: Department of Anesthesiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Blanc
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Electronic address: demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy; D019091:Critical Pathways; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016055:Urinary Retention / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
keywords: Colorectal; Enhanced recovery; Fast track; Urinary retention