Risk Factors for Urinary Retention Following Surgical Repair of Hip Fracture in Female Patients.

BACKGROUND/OBJECTIVES: Postoperative urinary retention (POUR) is a common event following surgical procedures. An increase in the number of elderly individuals who undergo hip fracture repair procedures is inevitable due to the aging of population. Postoperative urinary retention is associated with both early (infections, delirium) and late complications (urinary incontinence) of surgery. The objective of the current study is to direct attention to the less studied population of patients admitted to a geriatric rehabilitation ward following hip fracture repair who are at risk of POUR. DESIGN: Prospective single-center cohort study. SETTING: Academic tertiary hospital. MEASUREMENT: Postvoid bladder volume by ultrasonography (US). RESULTS: Postvoid bladder volume was measured by US in 88 consecutive female patients on the morning following their admission to the geriatric rehabilitation department. The mean age of the patients was 82.5 ± 6.5 years, and the frequency of POUR (defined as postvoid bladder volume ≥200 mL) was 37.5%. The POUR (n = 33) and non-POUR (n = 55) groups were similar with respect to most demographic and disease states. Multivariable stepwise logistic regression revealed a significant effect for opioid use (relative risk [RR] = 8.0, P < .001) and for treatment with anticholinergic medication (RR = 1.3, P = .046). There was an unexpectedly high proportion of patients with asymptomatic urinary retention (29 of the 33 patients, 88%). CONCLUSION: The high incidence of asymptomatic POUR in elderly patients calls for the need for improved screening tools for early identification and treatment.

Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients following hip arthroplasty.

We sought to determine if ANSS used for evaluating pressure sore risk also correlate with rehabilitation outcome and length following hip arthroplasty in elderly patients. This was a retrospective study conducted in a geriatric rehabilitation department during 2009. ANSS, admission albumin serum levels, mini-mental state examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, and rehabilitation length were studied. The final cohort included 201 patients: 160 (79.6%) females and 41 (20.4%) males. Mean age was 82.7±6.5 years. Mean discharge walking FIM score was 5.2±0.9. Mean length of rehabilitation was 19.9±7.8 days. ANSS correlated with discharge walking FIM scores (r=0.28; p=0.002), and with length of rehabilitation (r=-0.22; p=0.014) following adjustment for age, admission albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were associated with the discharge walking FIM scores (p<0.0001) and rehabilitation length (p=0.027) independent of age, admission albumin serum levels, gender, type of hip surgery, and the appearance of pressure sores. We conclude that the Norton scoring system may be used for predicting the outcome and the duration of rehabilitation in elderly patients following hip arthroplasty.