Urinary Retention is Rare After Total Joint Arthroplasty When Using Opioid-Free Regional Anesthesia

Background: Postoperative urinary retention (POUR) is a relatively common complication after total joint arthroplasty (TJA). Based on the findings of a randomized, prospective study from our institution, we abandoned the routine use of indwelling urinary catheters in patients undergoing elective TJA using opioicl-free spinal anesthesia. The aim of this study was to determine the incidence of and the risk factors for POUR in this patient population. Patients and Methods: A total of 842 consecutive patients underwent TJA between January 2012 and September 2014 using opioicl-free spinal anesthesia in whom indwelling urinary catheters were not used. Postoperative urinary retention was defined as the inability of a patient to void that necessitated the placement of either an indwelling urinary catheter or straight catheterization. Multivariate logistic regression analysis was used to determine risk factors for developing POUR. Results: In this cohort, 79 patients (79/842; 9.3%) developed POUR. Independent risk factors for POUR were history of a benign prostatic hyperplasia (P=.02), renal disease (P=.001), longer operative time (P=.003), and age older than 67 years (P=.02). No patients in this cohort developed neurogenic bladder. Conclusion: This study confirms that the routine use of indwelling urinary catheters for patients undergoing TJA using an opioid-free spinal anesthesia may not be warranted, Urinary catheters may be used selectively in patients at risk for subsequent urinary retention.