Why Are 40% of "Fast-Track" Patients Experiencing Urinary Retention?

How one program achieved a 5.5% POUR rate despite using strict catheterization thresholds and robust perioperative fluid therapy.

Clinical and surgical care principles underlying modern, evidence-based care and coordination for early discharge total joint arthroplasty (TJA), also known as fast track, rapid recovery, or enhanced recovery from surgery, have led to an increased prevalence of short-stay and same-day discharge for appropriate patients. Acute postoperative urinary retention (POUR) is a significant barrier to same-day and early discharge TJA as it can result in pathologic bladder distention and injury, urinary tract infection (with possible hematogenous periprosthetic infection), and catheterization-related complications.

The incidence of acute POUR following TJA has been documented to range from 0% to 75%, varying based on the perioperative practices of TJA programs; characteristics of study populations; and definitions, measurement, and treatment methods for acute urinary retention. The incidence of POUR in fast-track TJA has been reported in recent years and is surprisingly high. Bjerregaard et al reported a 40% incidence in a prospective study of 1062 elective primary total hip arthroplasties(THAs) and total knee arthroplasties (TKAs) performed in highly established fast-track programs. Scholten et al reported a 31.3% incidence in 307 TJAs performed in another established fast-track center.