Incidence of and risk factors for postoperative urinary retention in men after carotid endarterectomy

Abstract

ObjectiveThe goal of this study was to determine the incidence of postoperative urinary retention (POUR) in men after carotid endarterectomy (CEA) and to identify preventable risk factors for the development of this complication. MethodsAll male patients who underwent CEA from 2014 to June 2018 were identified. Exclusions included CEA with concomitant cardiac surgery, baseline dialysis, and indwelling or straight catheterization. POUR was the primary end point, defined as inability to void requiring catheterization within 24 hours postoperatively or after removal of a preoperatively placed Foley catheter. POUR was further classified as mild (single catheterization), moderate (multiple catheterizations), or severe (catheterization prolonging discharge or discharge with catheter). Logistic regression assessed for POUR risk factors. ResultsThere were 294 male patients who underwent CEA during the study period; 82 (28.2%) developed POUR. Of these, 48 (57.8%) were mild, 15 (18.1%) were moderate, and 20 (24.1%) were severe. At baseline, POUR was associated with older age, peripheral artery disease (PAD), chronic kidney disease, diabetes, ambulation deficit, prior urinary retention, and statin and chronic tamsulosin use. Overall, 31.6% (93) of the cohort had a Foley catheter placed before the procedure, and this was protective against POUR (no Foley vs Foley, 31.8% vs 20.4%; P = .043). Independent risk factors for POUR included prior urinary retention (odds ratio [OR], 3.4 [1.6-7.3]; P = .002), diabetes (OR, 2.1 [1.1-3.7]; P = .016), PAD (OR, 2.3 [1.1-5.2]; P = .036), and age (per year: OR, 1.1 [1.02-1.10]; P < .001). Preoperative Foley catheter placement remained protective (OR, 0.4 [0.2-0.7]; P = .003). Preoperative Foley catheter placement was not associated with urinary tract infection (preoperative Foley catheter: 0% vs 1%; P = .54). However, POUR was associated with an increased risk for urinary tract infections (10% vs 1%; P = .001), which was highest in severe POUR (20% vs 1%; P = .001). POUR was also associated with a discharge to rehabilitation (16% vs 4%; P = .002), with highest rates in the moderate and severe POUR cohorts (20% each). ConclusionsPOUR is common in men undergoing CEA, and almost a quarter of those with POUR have a discharge delay or are discharged with a Foley catheter. Preoperative Foley catheterization is protective against POUR and should be considered in older patients, diabetics, patients with PAD, and those with a history of urinary retention.