Postoperative Urinary Retention after Pediatric Orthopedic Surgery

Abstract

Background: Postoperative urinary retention is defined as an inability to void after surgery or the presence of a major residual volume after voiding that requires catheterization. Postoperative urinary retention prolongs hospital stay and often leads to bladder catheterization, which exposes patients to the risk of urinary tract infection. This study aims to describe the incidence of postoperative urinary retention among pediatric patients undergoing orthopedic surgery and to identify risk factors for this complication. Methods: The Pediatric Health Information System (PHIS) was used to identify children aged 1-18 years who underwent orthopedic surgery during 2012-2015. Collected from each patient’s record were demographic information, principal procedure during hospitalization, diagnosis codes for the hospitalization, the presence of neurologic/neuromuscular conditions and other complex chronic medical conditions, the total post-operative length of stay, and the presence of post-operative urinary retention. Results: There were 232,551 pediatric patients undergoing orthopedic surgery from 2012-2015 that met our inclusion criteria. There were 892 cases of postoperative urinary retention, for an overall incidence of 0.38%. The average length of stay for patients with postoperative urinary retention was 7.8 days compared to 1.7 days in those without. After adjusting for gender, race, and age, children with complex chronic neuromuscular conditions (OR 11.54 (95% CI 9.6-13.88), p = <0.001) and complex chronic non-neuromuscular medical conditions (OR 5.07 (95% CI 4.11 – 6.25 -), p = <0.001) had a substantially increased incidence of urinary retention. Surgeries on the spine (OR 3.98 (95% CI 3.28 - 4.82, p = <0.001) and femur/hip (OR 3.63 (95% CI 3.03 - 4.36), p = <0.001) were also associated with a substantially increased incidence of urinary retention. Conclusions: While the overall incidence of postoperative urinary retention in children undergoing orthopedic surgery is low, children with complex chronic neuromuscular conditions have substantially increased risk of experiencing this complication. In addition, complex chronic non-neuromuscular medical conditions and surgeries to the spine, hip, and femur also carry a notably increased risk for postoperative urinary retention. Clinicians should be aware of these risk factors and recognize that occurrence of postoperative urinary retention is likely to increase patient’s length of stay. Level of Evidence: Prognostic Level III KEY WORDS: Postoperative, urinary retention, pediatric orthopedics, surgery, risk factors.