Heart Rate Variability as a Novel Indicator for Predicting Postoperative Urinary Retention in Benign Prostatic Hyperplasia: Development and Internal Validation of a Predictive Nomogram.

Introduction: Postoperative urinary retention (POUR) is a complication of surgery defined as the inability to empty a full bladder. POUR can prolong hospital length of stay and increase rates of urinary tract infection in the postoperative period. Risk factors for the development of POUR include male sex, older age, select medications, and certain comorbid conditions. Surgical factors may also increase the risk of POUR. POUR occurs in up to 50% of patients undergoing colorectal surgery. Materials and Methods: This retrospective, single-center cohort study evaluated the incidence of POUR in patients admitted for colorectal surgery and were enrolled in a Colorectal Enhanced Surgical Recovery (CERAS) protocol. Our primary objective was to determine the incidence of POUR in patients treated under the CERAS protocol. Secondary objectives included evaluating the incidence of POUR in patients receiving intrathecal anesthesia. Results: Two hundred and twenty-eight patients were included. Sixty-six patients (28.9%) developed POUR during their hospitalization. Patients who developed POUR were more likely to be male (61.6% vs. 44.4%, P = 0.029) and tended to be older (mean ± standard deviation age, 61.4 ± 17.7 years vs. 56.8 ± 16.4 years; P = 0.069) compared to the non-POUR group. Regional anesthesia did not affect the incidence of POUR. Conclusions: We identified a rate of POUR in our CERAS patients consistent with previous studies. The risk of POUR increased with increasing age, male sex, and history of benign prostatic hyperplasia and diabetes mellitus. We found no difference in POUR incidence with the type of regional anesthesia utilized. The following core competencies are addressed in this article: Practice-Based Learning and Improvement and Medical Knowledge.

Postoperative urinary retention (POUR) is a common complication following colorectal surgery. The incidence of POUR among colorectal surgery patients varies widely, and the risk factors and outcomes of POUR are also debatable. This meta-analysis aims to systematically evaluate the risk factors for POUR in patients after colorectal surgery. PubMed, Web of Science, the Cochrane Library, Embase, Medline, and Chinese databases (CBM, CNKI, and WanFang Databases) were searched to identify relevant cohort studies (from inception to August 2022). Two researchers independently conducted literature quality evaluation and data extraction. All data were analyzed by using the Review Manager 5.4 software. Nineteen studies with 101,025 patients were included in this meta-analysis. The risk factors for POUR in colorectal surgery patients were male sex, older age, diabetes mellitus, urological diseases, tumor location in the lower rectum, APR, laparoscopic surgery, operation time ≥ 4h, postoperative date of urinary catheter removal, excessive intraoperative intravenous fluid volume, and postoperative ileus. The postoperative anastomotic leak, on the other hand, was not a risk factor for POUR. Multiple risk factors influence the incidence of POUR in patients undergoing colorectal surgery. To reduce the incidence of POUR in colorectal surgery patients, medical staff should identify risk factors early and enforce interventions to prevent them.

Study Design:Retrospective case series.Objectives:Postoperative urinary retention (POUR) represents a common postoperative complication of all elective surgeries. The aim of this study was to identify demographic, comorbid, and surgical factors risk factors for POUR in patients who underwent elective thoracolumbar spine fusion.Methods:Following institutional review board approval, patients who underwent elective primary or revision thoracic and lumbar instrumented spinal fusion in a 2-year period in tertiary and academic institution were reviewed. Sex, age, BMI, preoperative diagnosis, comorbid conditions, benign prostatic hyperplasia, diabetes, primary or revision surgery status, narcotic use, and operative factors were collected and analyzed between patients with and without POUR.Results:Of the 217 patients reviewed, 54 (24.9%) developed POUR. The average age for a patient with POUR was 67 ± 9, as opposed to 59 ± 10 for those without (P < .0001). Single-level fusions were associated with a 0% incidence of POUR, compared with 54.5% in 6 or more levels. The average hospital stay was increased by 1 day for those who had POUR (5.8 ± 3.3 vs 4.9 ± 3.9 days). There was no significant association with other demographic variables, comorbid conditions, or surgical factors.Conclusions:POUR was a common complication in our patient cohort, with an incidence of 24.9%. Our findings demonstrate that patients who developed POUR are significantly older and have larger constructs. Patients who developed POUR also had longer in-hospital stays. Although our study supports other findings in the spine literature, more prospective data is needed to define diagnostic criteria of POUR as well as its management.

Postoperative Urinary Retention in Patients Undergoing Lung Resection: Incidence and Risk Factors

BackgroundAcute postoperative urinary retention (POUR) is a common complication in patients with ischemic stroke following femoral artery puncture (FAP), leading to discomfort, delayed hospital discharge, and increased patient morbidity. The relevant risk factors are unclear; thus, a predictive tool is required to guide treatment decisions.ObjectiveTo develop and validate a nomogram to predict acute POUR in patients with ischemic stroke following FAP.MethodsWe retrospectively collected cases from 1729 patients with ischemic stroke from the electronic record system of Jiangmen Central Hospital from January 2021 to December 2023. A total of 731 patients were randomly divided into development (n = 511, 70%) and validation (n = 220, 30%) groups. Univariate and multivariate logistic regression analyses with backward stepwise regression were used to select the predictive variables, and a nomogram was developed. The discrimination was evaluated based on the area under the curve (AUC). Calibration was assessed using calibration plots and the Hosmer–Lemeshow test. Clinical applications were evaluated using decision curve analysis (DCA).ResultsThe incidence of acute POUR was 12.72%. Preoperative statin use within 24 h, operation type, intraoperative infusion, postoperative water intake within 3 h, postoperative pain, and postoperative anxiety were included in the nomogram. The AUC values were 0.764 [95% confidence interval (CI): 0.705–0.825] in the development group and 0.741 (95% CI: 0.615–0.856) in the validation group. The calibration plots showed good calibration. The p values in the Hosmer–Lemeshow tests were 0.962 and 0.315 for the development and validation groups, respectively. The DCA showed that patients could benefit from this nomogram.ConclusionA nomogram was developed to successfully predict acute POUR in patients with ischemic stroke following FAP. This nomogram is a convenient and effective tool for clinicians to aid in the prevention and early intervention of acute POUR.

ObjectiveThe purpose of this study is to compare the rates of urinary tract infection (UTI) and postoperative urinary retention (POUR) in patients undergoing lower limb arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization.MethodsWe conducted a meta-analysis of relevant randomized controlled trials (RCT) to compare the rates of UTI and POUR in patients undergoing total joint arthroplasty after either indwelling urinary catheterization or intermittent urinary catheterization. A comprehensive search was carried out to identify RCTs. Study-specific risk ratios (RR) with 95% confidence intervals (CI) were pooled. Additionally, a meta-regression analysis, as well as a sensitivity analysis, was performed to evaluate the heterogeneity.ResultsNine RCTs with 1771 patients were included in this meta-analysis. The results showed that there was no significant difference in the rate of UTIs between indwelling catheterization and intermittent catheterization groups (P>0.05). Moreover, indwelling catheterization reduced the risk of POUR, versus intermittent catheterization, in total joint surgery (P<0.01).ConclusionsBased on the results of the meta-analysis, indwelling urinary catheterization, removed 24-48 h postoperatively, was superior to intermittent catheterization in preventing POUR. Furthermore, indwelling urinary catheterization with removal 24 to 48 hours postoperatively did not increase the risk of UTI. In patients with multiple risk factors for POUR undergoing total joint arthroplasty of lower limb, the preferred option should be indwelling urinary catheterization removed 24-48 h postoperatively.Level of EvidenceLevel I.

BackgroundHeart Rate Variability (HRV) represents efferent vagus nerve activity which is suggested to be inversely related to fundamental mechanisms of tumorigenesis and to be a predictor of prognosis in various types of cancer. HRV is also believed to predict the occurrence and severity of post-operative complications. We aimed to determine the role of pre-operative HRV as a prognostic factor in overall and cancer free survival in patients with colorectal cancer.MethodsRetrospective analysis was performed in a detailed dataset of patients diagnosed with primary colorectal cancer between January 2010 and December 2016, who underwent curative surgical treatment. HRV was measured as time-domain parameters (SDNN (Standard Deviation of NN-intervals) and RMSSD (Root Mean Square of Successive Differences)) based on pre-operative 10 second ECGs. Groups were created by baseline HRV: Low HRV (SDNN <20ms or RMSSD <19ms) and normal HRV (SDNN ≥20ms or RMSSD ≥19ms). Primary endpoints were overall and cancer free survival.ResultsA total of 428 patients were included in this study. HRV was not significantly associated with overall survival (SDNN <20ms vs SDNN ≥20ms:24.4% vs 22.8%, adjusted HR = 0.952 (0.607–1.493), p = 0.829; RMSSD <19ms vs RMSSD ≥19ms:27.0% vs 19.5%, adjusted HR = 1.321 (0.802–2.178), p = 0.274) or cancer recurrence (SDNN <20ms vs ≥20ms:20.1% vs 18.7%, adjusted HR = 0.976 (0.599–1.592), p = 0.924; RMSSD <19ms vs ≥19ms, 21.5% vs 16.9%, adjusted HR = 1.192 (0.706–2.011), p = 0.511). There was no significant association between HRV and CEA-level at one year follow-up, or between HRV and occurrence of a post-operative complication or the severity of post-operative complications.ConclusionsHeart rate variability was not associated with overall or cancer free survival in patients with primary colorectal cancer who underwent curative surgical treatment. These results do not align with results found in studies including only patients with advanced cancer, which suggests that there is only an association in the other direction, cancer causing low HRV.

While epidemiological studies have examined the effects of exposure to particulate matter with diameter ≤2.5μm (PM2.5) on heart rate variability (HRV) on a daily basis, there is a need for more granular data to better understand the ultrashort-term effects of PM2.5 on HRV. This study aimed to investigate the minute-level association between PM2.5 exposure and HRV using real-time personal monitoring data, focusing on time-lagged effects in vulnerable populations. We collected minute-by-minute data of PM2.5 and HRV using a wearable device from 73 individuals, with 3 days of continuous observations per participant (total 315,360 observations). PM2.5 and electrocardiogram (ECG)-derived HRV indices, including the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD), were continuously measured for five days using wearable devices. Distributed lag non-linear and linear mixed-effects models were used to evaluate exposure-response relationships. PM2.5 exposure was significantly associated with acute HRV reductions within 180min. SDNN decreased by -8.04% (95% CI: 11.10% to -4.88%) at the initial lag following exposure, peaking at approximately 49min and gradually attenuating thereafter, and RMSSD decreased by -4.17% (95% CI: 7.23% to -1.00%) at the initial lag, with a similar attenuation pattern beyond 38min. More pronounced effects occurred during nighttime (18:00-06:00), with SDNN decreasing by -13.9% (95% CI: 17.81% to -9.80%) and RMSSD by -7.43% (95% CI: 11.13% to -3.57%). Females exhibited a more immediate HRV decline at the initial lag (SDNN: 10.24%, RMSSD: 6.39%) compared to males (SDNN: 4.44%, RMSSD: 8.61%). Patients with arrhythmia showed the greatest reductions at the initial lag (SDNN: 11.42%, RMSSD: 15.95%). This study highlights the immediate autonomic impact of PM2.5 exposure, emphasizing its differential effects by time of day, sex, and health status. Findings underscore the importance of personal air pollution monitoring and targeted interventions for high-risk populations.

Background: Low heart rate variability (HRV) is associated with major vascular risk factors for cognitive decline, including hypertension and cardiovascular disease (CVD). Therefore, we hypothesized that higher HRV during mid- to late-life is associated with better cognitive performance. Methods: In a subset of participants from the Multi-Ethnic Study of Atherosclerosis (N = 2,961; aged 45-84 years; 55% female; 40% white, 22% African-American, 25% Hispanic, and 13% Chinese-American), we used multivariate linear regression to study the relationship of short-term HRV to global cognitive performance as measured by the Cognitive Abilities Screening Instrument (CASI; score range 0-100). Two measures of HRV, the standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD), were computed at Exam 1 (2000-2002) and Exam 5 (2010-2012). CASI was administered at Exam 5. Results: In age-, race-, sex- and education-adjusted models, Exam 1 SDNN was significantly associated with performance on the CASI ( β = 0.74 ± 0.22; P &lt; 0.001). This association remained significant after adjustment for cardiovascular risk factors, including prevalent CVD, medication use, and APOE ε4 allele carriage ( β = 0.53 ± 0.23; P = 0.019). Furthermore, participants with highest quartile Exam 1 SDNN scored better than the adjusted mean CASI score (0.61 ± 0.22 points higher; P = 0.022), and 0.81 ± 0.29 points higher than other quartiles ( P = 0.006); participants in other Exam 1 SDNN quartiles scored similarly to each other and to the adjusted mean. In contrast, there were no associations between CASI score and Exam 5 SDNN, Exam 1 RMSSD, or Exam 5 RMSSD after adjustment for cardiovascular risk factors, and no interactions between HRV and race or APOE were present. Conclusions: Highest quartile 10-year antecedent SDNN is associated with better global cognitive performance in a multi-ethnic population of middle-aged and elderly adults, independent of sociodemographic factors, traditional cardiovascular risk factors, APOE status, and prevalent CVD. These results suggest that mid- to late-life HRV may be an early predictor of future cognitive ability.

Traditional electrocardiography (ECG)-derived heart rate variability (HRV) and photoplethysmography (PPG)-derived "HRV" (termed PRV) have been reported interchangeably. Any potential dissociation between HRV and PRV could be due to the variability in pulse arrival time (PAT; time between heartbeat and peripheral pulse). This study examined if PRV is equivalent to ECG-derived HRV and if PRV's innate error makes it a high-quality measurement separate from HRV. ECG data from 1084 subjects were obtained from the PhysioNet Autonomic Aging dataset, and individual PAT dispersions for both the wrist (n = 42) and finger (n = 49) were derived from Mol et al. (Exp Gerontol. 2020; 135: 110938). A Bayesian simulation was constructed whereby the individual arrival times of the PPG wave were calculated by placing a Gaussian prior on the individual QRS-wave timings of each ECG series. The standard deviation (σ) of the prior corresponds to the PAT dispersion from Mol et al. This was simulated 10,000 times for each PAT σ. The root mean square of successive differences (RMSSD) and standard deviation of N-N intervals (SDNN) were calculated for both HRV and PRV. The Region of Practical Equivalence bounds (ROPE) were set a priori at ± 0.2% of true HRV. The highest density interval (HDI) width, encompassing 95% of the posterior distribution, was calculated for each PAT σ. The lowest PAT σ (2.0 SD) corresponded to 88.4% within ROPE for SDNN and 21.4% for RMSSD. As the σ of PAT increases, the equivalence of PRV and HRV decreases for both SDNN and RMSSD. The HDI interval width increases with increasing PAT σ, with the HDI width increasing at a higher rate for RMSSD than SDNN. For individuals with greater PAT variability, PRV is not a surrogate for HRV. When considering PRV as a unique biometric measure, SDNN may have more favorable measurement properties than RMSSD, though both exhibit a non-uniform measurement error.

Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair

Unraveling the complex interplay between curved tunnels and drivers’ physiological responses: An HRV perspective

BackgroundLower heart rate variability (HRV), indicating worse cardiac autonomic function, is associated with cardiovascular risk factors for dementia. We hypothesized that lower HRV would be associated with neuroimaging biomarkers for dementia‐related pathology independent of cardiovascular risk factors.MethodDuring MESA Exam 6 (2016‐19), 256 white and African‐American Wake Forest site participants completed 3T brain MRI, and 159 further completed Aβ‐PET imaging. HRV was calculated as standard deviation of normal‐to‐normal intervals (SDNN) and root mean square of successive differences (RMSSD) from 10‐second electrocardiogram at Exam 1 (2000‐02) and Exam 5 (2010‐12). We related continuous (log2‐normalized) HRV to neuroimaging parameters including mean temporal lobe cortical thickness, neurite orientation dispersion and density imaging (NODDI) free water in gray (gmFW) and white matter (wmFW), and presence of cerebral microbleeds (CMBs), lacunes, and Aβ positivity (Pittsburgh Compound B SUVR ≥1.21) using multivariable linear and logistic regression, and examined race and sex interactions. To account for potential non‐linearity, we also considered the association of lowest quartile HRV to neuroimaging markers. Regression coefficients (β [95% CI]; standard deviation units) and odds ratios (OR [95% CI]) are adjusted for age, race, sex, education, systolic blood pressure, body mass index, smoking, hypertension medication use, diabetes, and APOE genotype.ResultIn 254 participants (Exam 6 age 72.2±6.9 years; 58.7% female; 47.2% white) with HRV measurements, lower continuous Exam 1 SDNN (β = ‐0.23 [‐0.39, ‐0.07]) and RMSSD (β = ‐0.19 [‐0.33, ‐0.05]) were associated with higher wmFW. Interactions showed that CMBs were associated with lowest quartile Exam 1 SDNN (OR = 3.76 [1.15, 12.25]) and Exam 5 RMSSD (OR = 3.36 [1.07, 10.54]) in males only (sex interaction P&lt;0.001), and with Exam 1 SDNN (OR = 2.58 [1.04, 6.45]) in African‐Americans only (race interaction P = 0.039). Lower HRV was not associated with cortical thickness or presence of lacunes. In 152 participants with Aβ‐PET, no associations with Aβ deposition were found.ConclusionLower HRV from up to 16 years prior may be associated with increased neuroinflammation as measured by free water in older adults. Associations between HRV and cerebral small vessel disease markers may differ by sex or race.

Indwelling catheter is a routine procedure in surgical patients. Studies have shown that prolonged indwelling urinary catheterization increases the risk of postoperative urinary tract infection. Although early removal of the urinary catheter after operation can reduce the risk of postoperative urinary symptoms and tract infections, it may lead to postoperative anesthetic dysuria. Therefore, this study investigates the urinary retention and related risk factors in patients after thoracoscopic lobectomy under general anesthesia. The clinical data of 214 patients who underwent thoracoscopic lobectomy in the Department of Thoracic Surgery of a tertiary class A cancer hospital in Beijing from July 2020 to April 2021 were collected. A risk prediction model was established by logistic regression analysis, and the prediction effect was determined using the area under the receiver operating characteristic (ROC) curve. The incidence of indwelling catheter after thoracoscopic lobectomy was 44.8% (96/214). Sex (OR = 21.102, 95% CI: 2.906–153.239, P=0.003), perception of shame (OR = 74.256, 95% CI: 6.171–893.475, P=0.001), age (OR = 1.095, 95% CI: 1.014–1.182, P=0.021), and bed rest time (OR = 1.598, 95% CI: 1.263–2.023, P < 0.021) were the factors influencing urinary retention after thoracoscopic lobectomy. This model can effectively predict the occurrence of postoperative urinary retention in patients with lung cancer and help medical staff to intervene effectively before the onset of urinary retention, which provides reference for preventive treatment and nursing intervention.

ERAS guidelines recommend early removal of urinary drainage after colorectal surgery to reduce the risk of catheter-associated urinary tract infections (CAUTI). Another recommendation is the postoperative use of epidural analgesia (EA). In many types of surgery, EA was shown to increase the risk of postoperative urinary retention (POUR). This study determines the impact of early urinary catheter removal on the incidence of POUR and CAUTI under EA after colorectal surgery. Eligible patients were scheduled for colorectal surgery within the local ERAS protocol between April 2015 and September 2016. Urinary drainage was removed on the first postoperative day while EA was still in place (early removal group (ER)). The incidences of POUR and CAUTIs were recorded prospectively. Results were compared with a historical control (CG), which was operated between October 2013 and March 2015. POUR occurred significantly more often in the ER (ER 7.8%; CG 2.6%), while CAUTIs were significantly less frequent in the ER (13.8%) compared with the CG (30.4%). Patients who developed POUR were characterised by a significantly higher rate of abdominoperineal resections, by a higher frequency of rectal cancer, and a higher male-to-female ratio compared with patients who did not develop POUR. Early removal of urinary drainage after colorectal surgery while EA is still in place is feasible; it reduces the incidence of CAUTI but increases the risk of POUR. Thus, screening for POUR in patients with failure to void after six to 8 h is mandatory under these clinical conditions.