Quantification of risk factors in 500 patients with postoperative urinary retention.

INTRODUCTION: An Institutional Quality and Safety Initiative to reduce postoperative urinary retention (POUR) and improve patient safety indicators (PSIs) was undertaken after a nurse driven protocol for catheter removal lead to an increase in POUR. The aim of this study was to identify the number of risk factors present in patients with POUR while examining the prevalence of those risk factors individually. MATERIALS AND METHODS: A retrospective review of our institution's surgical database was performed to identify 500 consecutive cases of POUR between July 1, 2013 and July 1, 2014. POUR was defined as the inability to void postoperatively with bladder scan volumes greater than 450 mL and subsequent need for catheterization with an output greater than 450 mL. These records were individually reviewed for 15 known independent risk factors for urinary retention. Patients with incomplete records or preoperative baseline urinary retention requiring catheterization were excluded. RESULTS: Of the 500 consecutive patients with POUR, 288 (57.6%) were male and 212 (42.4%) were female. At the time of voiding trial, all 500 patients with POUR (100%) had at least one perioperative risk factor identified and over 75% had six or more (mean 6.88, median 7, range 1-12). CONCLUSIONS: Multiple perioperative risk factors are present in the vast majority of patients with POUR. Many of the risk factors are modifiable and represent an opportunity for intervention. This could ultimately lead to a risk profile which could be used to optimize timing of postoperative voiding trials, thus improving patient care (improve PSIs and patient comfort, reduce trauma) while maintaining low rates of CAUTI.