Predictors of Postoperative Urinary Retention in Outpatient Minimally Invasive Hysterectomy

Abstract

Study objective: To identify risk factors associated with postoperative urinary retention in patients undergoing outpatient minimally invasive hysterectomy.

Design: A retrospective cohort study.

Setting: An academic medical center.

Patients: All patients undergoing outpatient minimally invasive hysterectomy between January 2013 and July 2018 were considered for inclusion in the study.

Interventions: Outpatient laparoscopic, vaginal, or robotically assisted laparoscopic hysterectomy.

Measurements and main results: Four hundred forty-four patients met the inclusion criteria. Postoperative urinary retention occurred in 94 patients, and 347 patients successfully passed their voiding trial in the postanesthesia care unit for a pass rate of 79%. Demographic characteristics were similar, except patients who experienced postoperative urinary retention were less likely to be menopausal (23.4% vs 34.7%, p = .038). Those with urinary retention received more perioperative opioids (morphine milligram equivalent of 14.4 mg vs11.2 mg, p = .012), had longer operative times (122.9 ± 55.6 vs 95.7 ± 42.3 minutes, p < .01), and experienced more blood loss (105.3 ± 134.4 vs 78.5 ± 86.8 mL, p = .025). The rate of urinary tract infections was similar. Logistic regression analysis showed that the route of hysterectomy and age were not associated with an increased risk for urinary retention, whereas a longer operative time and higher doses of perioperative opioid use were.

Conclusion: In patients undergoing minimally invasive outpatient hysterectomy, a longer operative time and increased perioperative narcotic use increases the risk of postoperative urinary retention.

Keywords: Minimally invasive hysterectomy; Outpatient hysterectomy; Urinary retention; Voiding trial.