Fecal impaction is associated with postoperative urinary retention after hip fracture surgery - 05/12/20

Doi : 10.1016/j.rehab.2020.101464

Maëlys Teng, MD ^a,^b,⁎ , Lorène Zerah, MD MSc ^a, Audrey Rouet, MD MSc ^a, Charlotte Tomeo, MD ^a, Marc Verny, MD PhD ^a, Judith Cohen-Bittan, MD ^a, Jacques Boddaert, MD PhD ^a,^c, Rebecca Haddad, MD MSc ^b,^d,^e
^a Sorbonne Université, Assistance Publique–Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière–Charles Foix, Unit of Peri-Operative Geriatric Care (UPOG), 47-83 boulevard de l’Hôpital, 75013 Paris, France
^b Sorbonne Université, GRC 001, GREEN Groupe de recherche en Neuro-Urologie, Assistance Publique–Hôpitaux de Paris (APHP), Hôpital Rothschild 5 rue Santerre, 75012 Paris, France
^c Sorbonne Université, UMR INSERM U1135, 15-21 rue de l’Ecole de médecine, 75006 Paris, France
^d Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
^e Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, St Pietersnieuwstraat 33, 9000 Ghent, Belgium

^⁎Corresponding author: Hôpital Rothschild, Service de Médecine Physique et de Réadaptation Neurologique, 5 rue Santerre, 75012 Paris, FranceHôpital Rothschild, Service de Médecine Physique et de Réadaptation Neurologique5 rue SanterreParis75012France

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Abstract

Background. Postoperative urinary retention (POUR) is a common hip fracture (HF) complication. Although fecal impaction (FI) is one of the oft-cited causes of POUR in clinical practice, evidence regarding this association is scarce.

Objective. The aim of this study was to determine whether FI was associated with POUR after HF surgery in older patients.

Methods. All patients consecutively admitted after a HF surgery in a geriatric perioperative unit were included in this cross-sectional study. FI was systematically assessed by a digital rectal exam at admission and according to clinical suspicion during the hospital stay. The dependent variable was POUR, systematically screened according to the department protocol and defined as a bladder volume > 400 ml requiring catheterization. The association between FI and POUR was assessed by multivariable analysis.

Results. A total of 256 patients were included (mean [SD] age 86 [6] years), 76% women): 108 (42%) presented FI and 63 (25%) POUR. The frequency of FI was higher with than without POUR (73% vs 32%, P<0.001). On multivariable analysis, after adjusting for age, sex, Cumulative Illness Rating Scale score and anticholinergic load, FI was the only factor independently associated with POUR (odds ratio 4.78 [95% confidence interval 2.44-9.71], P<0.001.

Conclusions. FI was the only independent factor associated with POUR after HF surgery in older adults. Further studies are needed to optimize perioperative geriatric care including FI and POUR assessment and management.

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Keywords : Post-operative urinary retention, fecal impaction, hip fracture, older, lower urinary tract symptoms, rehabilitation

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Fecal impaction is associated with postoperative urinary retention after hip fracture surgery - 05/12/20

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