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Franco Carli - One of the best experts on this subject based on the ideXlab platform.
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Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided Bladder Catheterization.
Minerva anestesiologica, 2011Co-Authors: T Balderi, Giovanni Mistraletti, E D'angelo, Franco CarliAbstract:Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective Bladder Catheterization. Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective Bladder Catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05. Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%). Bladder scanners timely detect POUR following lower joint arthroplasty, making elective Bladder Catheterization unnecessary.
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incidence of postoperative urinary retention pour after joint arthroplasty and management using ultrasound guided Bladder Catheterization
Minerva Anestesiologica, 2011Co-Authors: T Balderi, Giovanni Mistraletti, E Dangelo, Franco CarliAbstract:BACKGROUND Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective Bladder Catheterization. METHODS Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective Bladder Catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05. RESULTS Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%). CONCLUSION Bladder scanners timely detect POUR following lower joint arthroplasty, making elective Bladder Catheterization unnecessary.
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Less urinary tract infection by earlier removal of Bladder catheter in surgical patients receiving thoracic epidural analgesia.
Regional anesthesia and pain medicine, 2009Co-Authors: Cedrick Zaouter, Pepa Kaneva, Franco CarliAbstract:Background and Objectives: It is common practice to catheterize the Bladder in the presence of epidural analgesia and to leave the Bladder catheter in situ to avoid postoperative urinary retention. However, Bladder Catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the Bladder Catheterization discontinued on the morning after surgery with the epidural still functioning. Methods: Patients at low risk for postoperative urinary retention, scheduled for thoracic and abdominal surgery and receiving continuous thoracic epidural analgesia, were randomized on the morning after surgery to 2 groups: in the early removal group (n = 105), the Bladder catheter was removed on the same morning after surgery, whereas in the standard group (SG) (n = 110), the Bladder catheter was removed when epidural analgesia was discontinued (3-5 days). Urinary Bladder volume was assessed by ultrasound. Primary and secondary outcomes were the incidence of UTI and rate of reCatheterization. Results: Two hundred fifteen patients were randomized. There were 17 UTI cases in total, with 15 (14%) in the SG and 2 (2%) in the early removal group (P = 0.004). The incidence of reCatheterizations was not different between the 2 groups (P = 0.09) and did not correlate with the site of epidural insertion. When matched for the types of surgery, the duration of hospital stay was longer in the patients who contracted UTI (P = 0.004). There were more patients older than 65 years in the SG. Conclusions: Leaving the Bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the Bladder catheter on the morning after surgery does not lead to higher rate of Catheterizations.
David Appleby - One of the best experts on this subject based on the ideXlab platform.
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The utility of Bladder Catheterization in total hip arthroplasty.
Clinical orthopaedics and related research, 2005Co-Authors: Richard Iorio, William Whang, William L. Healy, Douglas A. Patch, Soheil Najibi, David ApplebyAbstract:The use of a urinary Bladder catheter in patients having a total hip arthroplasty is controversial. Universal insertion of an indwelling catheter before a total hip arthroplasty, and insertion of a catheter postoperatively as necessary, are accepted variations of care. From 1993 to 1999, 719 patients having primary, unilateral total hip arthroplasties were randomized by surgeons into two groups: a group of patients who had universal preoperative insertion of an indwelling Bladder catheter (340 patients) and an observation group who had Catheterization as needed (379 patients). Catheterization was required for 295 of these 379 patients (77.8%). Patients were followed up using a total hip arthroplasty database, which recorded all complications. Six patients (1.8%) in the universal catheter insertion group had a urinary tract infection develop. Nine patients (2.4%) in the catheter as necessary group had a urinary tract infection develop. There was no significant difference in incidence of urinary tract infections between the two groups. Female gender and increasing age were associated with a higher incidence of urinary tract infection in both groups. The average length of stay in the hospital for the universal catheter group was 4.8 days, and the average length of stay for the catheter as necessary group was 4.5 days. There was no significant difference in length of stay in the hospital between the two groups. The universal catheter group had an average 590 dollars higher hospital cost for their total hip arthroplasties, which was significant. Routine preoperative Bladder Catheterization may not be warranted in patients having total hip arthroplasties. Postoperative Catheterization as necessary may be more cost effective.
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The role of Bladder Catheterization in total knee arthroplasty
Clinical orthopaedics and related research, 2000Co-Authors: Richard Iorio, William L. Healy, Douglas A. Patch, David ApplebyAbstract:The use of a urinary Bladder catheter in the perioperative period for patients undergoing total knee arthroplasty is controversial. In the current study, two Bladder management protocols were studied. One group of patients had an indwelling catheter inserted into the Bladder before total knee arthroplasty. The other group of patients was observed and treated for urinary retention as necessary. From 1993 to 1998, 652 patients undergoing primary, unilateral total knee arthroplasty were randomized by surgeon into two groups: one group underwent preoperative insertion of an indwelling Bladder catheter (306 patients), and one group (346 patients) had a catheter inserted postoperatively as necessary. Sixty-six percent (229 of 346) of these patients required Catheterization (203 had indwelling catheters and 26 had intermittent straight catheters). A urinary tract infection developed in five patients (1.6%) in whom a catheter was inserted preoperatively. A urinary tract infection developed in six patients (1.7%) in whom a catheter was inserted if necessary. Five of these urinary tract infections developed in patients with delayed indwelling Bladder catheters. A urinary tract infection did not develop in any patient in whom a straight catheter was inserted. There was no significant difference in the length of stay in the hospital between the two groups. The group in whom a catheter always was inserted generated $491 greater cost for total knee arthroplasty than patients in whom a catheter was inserted if necessary.
Michael A Mont - One of the best experts on this subject based on the ideXlab platform.
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the effect of Bladder Catheterization on ambulation and venous thromboembolism following total knee arthroplasty an institutional analysis
Journal of Arthroplasty, 2020Co-Authors: Peter A Gold, Luke J Garbarino, Hiba K Anis, Nipun Sodhi, Jonathan R Danoff, Sreevathsa Boraiah, Vijay J Rasquinha, Jamie C Heimroth, Michael A MontAbstract:Abstract Background Although intermittent catheters are immediately removed, indwelling Catheterization may lead to decreased ambulation and participation in physical therapy, critical components to post-total knee arthroplasty (TKA) management. Therefore, this study aimed to compare the effect of Catheterization treatments on (1) postoperative ambulation distances, (2) deep vein thromboses (DVTs), and (3) pulmonary emboli (PEs) following TKA. Methods A total of 9123 prospectively collected primary TKA patients were assessed based on postoperative catheter status. Patient demographics, Charlson Comorbidity Indices, body mass indices, DVT prophylaxes, first ambulation distances, DVTs, and PEs were collected at approximately mean 12 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models in order to compare Catheterization techniques. Results There were 1193 patients who had urinary retention and treated with either indwelling only (62%, n = 734), both indwelling and intermittent Catheterizations (13%, n = 160), or intermittent only (25%, n = 299). Multivariate analyses found that indwelling catheter-only use had an 11% decrease in ambulation distance (P Conclusion This study showed that the use of an indwelling catheter for treatment of urinary retention significantly decreased TKA patient ambulation distance and subsequently increased the risk for DVTs. This information is important as we would recommend the treatment with intermittent Catheterization rather than indwelling catheters to decrease the risk of immobilization and postoperative DVTs.
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the effect of Bladder Catheterization technique on postoperative urinary tract infections after primary total hip arthroplasty
Journal of Arthroplasty, 2020Co-Authors: Luke J Garbarino, Peter A Gold, Hiba K Anis, Nipun Sodhi, Joshua G Burshtein, Aaron L Burshtein, Jonathan R Danoff, Sreevathsa Boraiah, Vijay J Rasquinha, Michael A MontAbstract:Abstract Background Urinary Bladder catheters are potential sources of infection after total hip arthroplasty (THA). Therefore, the goal of this study was to determine if intermittent Catheterization provides a decreased risk of postoperative urinary tract infections (UTIs) compared with indwelling Catheterization in THA patients. Methods Patients undergoing THA at 15 hospitals within a large health system were prospectively collected between 2017 and 2019 and then stratified based on Catheterization technique: no-catheter; indwelling catheter–only; intermittent catheter–only; and both intermittent and indwelling catheter. Patient demographics, medical comorbidities, anesthesia types, and postoperative UTIs were assessed. Independent Student t-tests were used to perform univariate analyses for the Catheterization groups. Multiple linear regression models were used to compare the different groups while controlling for confounding variables. Results There were a total of 7306 THA patients recorded with 5513 (75%) no-catheter, 1181 (16%) indwelling catheter–only, 285 (3.9%) intermittent catheter–only, and 327 (4.5%) indwelling and intermittent Catheterization patients. A total of 580 patients experienced postoperative UTI. Urinary Bladder Catheterization increased the risk of postoperative UTIs (P Conclusion This study found that patients treated with indwelling Catheterization, with or without preceding intermittent Catheterization, were significantly more likely to experience UTIs. Therefore, in an effort to decrease the risk of UTIs, THA patients experiencing postoperative urinary retention should be treated with intermittent Catheterization.
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The Effect of Bladder Catheterization Technique on Postoperative Urinary Tract Infections After Primary Total Hip Arthroplasty.
The Journal of arthroplasty, 2020Co-Authors: Luke J Garbarino, Peter A Gold, Nipun Sodhi, Joshua G Burshtein, Aaron L Burshtein, Jonathan R Danoff, Sreevathsa Boraiah, Vijay J Rasquinha, Hiba Anis, Michael A MontAbstract:Urinary Bladder catheters are potential sources of infection after total hip arthroplasty (THA). Therefore, the goal of this study was to determine if intermittent Catheterization provides a decreased risk of postoperative urinary tract infections (UTIs) compared with indwelling Catheterization in THA patients. Patients undergoing THA at 15 hospitals within a large health system were prospectively collected between 2017 and 2019 and then stratified based on Catheterization technique: no-catheter; indwelling catheter-only; intermittent catheter-only; and both intermittent and indwelling catheter. Patient demographics, medical comorbidities, anesthesia types, and postoperative UTIs were assessed. Independent Student t-tests were used to perform univariate analyses for the Catheterization groups. Multiple linear regression models were used to compare the different groups while controlling for confounding variables. There were a total of 7306 THA patients recorded with 5513 (75%) no-catheter, 1181 (16%) indwelling catheter-only, 285 (3.9%) intermittent catheter-only, and 327 (4.5%) indwelling and intermittent Catheterization patients. A total of 580 patients experienced postoperative UTI. Urinary Bladder Catheterization increased the risk of postoperative UTIs (P < .001) in univariate analyses. Multiple linear regression models showed that indwelling catheter-only (OR: 2.178, P < .001), intermittent Catheterization (OR: 1.975, P = .003), and both indwelling and intermittent (OR: 2.372, P = .002) were more likely to experience UTIs compared with no catheters. This study found that patients treated with indwelling Catheterization, with or without preceding intermittent Catheterization, were significantly more likely to experience UTIs. Therefore, in an effort to decrease the risk of UTIs, THA patients experiencing postoperative urinary retention should be treated with intermittent Catheterization. Copyright © 2020 Elsevier Inc. All rights reserved.
Richard Iorio - One of the best experts on this subject based on the ideXlab platform.
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The utility of Bladder Catheterization in total hip arthroplasty.
Clinical orthopaedics and related research, 2005Co-Authors: Richard Iorio, William Whang, William L. Healy, Douglas A. Patch, Soheil Najibi, David ApplebyAbstract:The use of a urinary Bladder catheter in patients having a total hip arthroplasty is controversial. Universal insertion of an indwelling catheter before a total hip arthroplasty, and insertion of a catheter postoperatively as necessary, are accepted variations of care. From 1993 to 1999, 719 patients having primary, unilateral total hip arthroplasties were randomized by surgeons into two groups: a group of patients who had universal preoperative insertion of an indwelling Bladder catheter (340 patients) and an observation group who had Catheterization as needed (379 patients). Catheterization was required for 295 of these 379 patients (77.8%). Patients were followed up using a total hip arthroplasty database, which recorded all complications. Six patients (1.8%) in the universal catheter insertion group had a urinary tract infection develop. Nine patients (2.4%) in the catheter as necessary group had a urinary tract infection develop. There was no significant difference in incidence of urinary tract infections between the two groups. Female gender and increasing age were associated with a higher incidence of urinary tract infection in both groups. The average length of stay in the hospital for the universal catheter group was 4.8 days, and the average length of stay for the catheter as necessary group was 4.5 days. There was no significant difference in length of stay in the hospital between the two groups. The universal catheter group had an average 590 dollars higher hospital cost for their total hip arthroplasties, which was significant. Routine preoperative Bladder Catheterization may not be warranted in patients having total hip arthroplasties. Postoperative Catheterization as necessary may be more cost effective.
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The role of Bladder Catheterization in total knee arthroplasty
Clinical orthopaedics and related research, 2000Co-Authors: Richard Iorio, William L. Healy, Douglas A. Patch, David ApplebyAbstract:The use of a urinary Bladder catheter in the perioperative period for patients undergoing total knee arthroplasty is controversial. In the current study, two Bladder management protocols were studied. One group of patients had an indwelling catheter inserted into the Bladder before total knee arthroplasty. The other group of patients was observed and treated for urinary retention as necessary. From 1993 to 1998, 652 patients undergoing primary, unilateral total knee arthroplasty were randomized by surgeon into two groups: one group underwent preoperative insertion of an indwelling Bladder catheter (306 patients), and one group (346 patients) had a catheter inserted postoperatively as necessary. Sixty-six percent (229 of 346) of these patients required Catheterization (203 had indwelling catheters and 26 had intermittent straight catheters). A urinary tract infection developed in five patients (1.6%) in whom a catheter was inserted preoperatively. A urinary tract infection developed in six patients (1.7%) in whom a catheter was inserted if necessary. Five of these urinary tract infections developed in patients with delayed indwelling Bladder catheters. A urinary tract infection did not develop in any patient in whom a straight catheter was inserted. There was no significant difference in the length of stay in the hospital between the two groups. The group in whom a catheter always was inserted generated $491 greater cost for total knee arthroplasty than patients in whom a catheter was inserted if necessary.
T Balderi - One of the best experts on this subject based on the ideXlab platform.
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Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided Bladder Catheterization.
Minerva anestesiologica, 2011Co-Authors: T Balderi, Giovanni Mistraletti, E D'angelo, Franco CarliAbstract:Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective Bladder Catheterization. Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective Bladder Catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05. Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%). Bladder scanners timely detect POUR following lower joint arthroplasty, making elective Bladder Catheterization unnecessary.
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incidence of postoperative urinary retention pour after joint arthroplasty and management using ultrasound guided Bladder Catheterization
Minerva Anestesiologica, 2011Co-Authors: T Balderi, Giovanni Mistraletti, E Dangelo, Franco CarliAbstract:BACKGROUND Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective Bladder Catheterization. METHODS Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective Bladder Catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05. RESULTS Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%). CONCLUSION Bladder scanners timely detect POUR following lower joint arthroplasty, making elective Bladder Catheterization unnecessary.