Researchers have identified risk factors for urinary retention following minor thoracic surgery and developed a scoring system for predicting development of this complication, according to an online report in Interactive CardioVascular and Thoracic Surgery.
“The use of the developed scoring system may help in identifying those high-risk patients who need more aggressive management to prevent bladder overdistension and associated urinary complications,” the researchers concluded.
Kun Woo Kim, MD, of Gachon University Gil Medical Center in Incheon, Korea, and colleagues studied 292 patients who underwent thoracic surgery without a pre- or intraoperative indwelling urinary catheter under general anesthesia. The most common surgical procedure was wedge resection of lung parenchyma, which was performed on 176 patients.
Postoperative urinary retention (POUR), which was defined as a post-void residual volume of more than 200 mL, developed in 34 (11.6%) of the 292 patients. The researchers identified age 40 years and older, male gender, diabetes mellitus, and being a candidate for lung resection as independent risk factors. These factors were associated with a 12.4, 5.3, 7.0, and 17.3 times increased odds of POUR, respectively. To each factor, they assigned points: 2, 1, 1, and 2 points, respectively. The points are added to arrive at a cumulative score. The cut-off value for a model predicting POUR was 5 points, which resulted in 73% sensitivity and 90% specificity, according to the investigators.
Dr. Kim’s group noted that POUR has clinical implications, such as delayed discharge, potential risk of systemic infection from urinary catheterization, and possibly long-term bladder dysfunction.
“With recent advances in the field of thoracic surgery, the awareness and identification of patients at risk of developing POUR assumes greater significance,” the authors wrote. “Specifically, it can impact minor thoracic surgery including fast-track and minimally invasive surgical procedures whose advantages can be mitigated by prolonged hospital stays and the eventual economic burden resulting from POUR.”
In their discussion of study limitations, the researchers noted that their cohort mainly consisted of patients who underwent relatively minor thoracic surgery, a group not representative of all thoracic surgery patients. “Thus, the scoring system that we suggest cannot tell which of the patients who underwent intraoperative catheterization will be at higher risk of POUR.”