Changes In Anesthesia Can Reduce Periprocedural Urinary Retention After EVAR
Andres Guerra, MD, Calvin Chao, MD, Gabriel A. Wallace, MD, Mark K. Eskandari, MD.
Northwestern Memorial Hospital, Chicago, IL, USA.
OBJECTIVES: Enhanced recovery after surgery (ERAS) programs provide a streamlined approach for expedient post-operative care of high-volume procedures. Endovascular aortic repair (EVAR) has become standard treatment for abdominal aortic aneurysms (AAA) and implementation of an early recovery program is warranted. Post-operative urinary retention (POUR) remains a problem lending to longer hospital stays and patient discomfort. We aim to demonstrate the utility of monitored anesthetic care (MAC) as a modality to minimize urinary retention following EVAR. METHODS: Single-center retrospective review from January 2017-March 2020 of all patients undergoing standard EVAR under general anesthesia (GA) or MAC. Demographics, medical history, operative details, prostate measurements, and outcomes were collected and analyzed by two independent data extractors. Prostate volume was measured by multiplying transverse, antero-posterior, and cranio-caudal measurements of the prostate on computed tomography scans then multiplied by 0.52. Urinary retention was defined as any requirement of straight catheterization, urinary catheter replacement, or discharge with urinary catheter. Chi square tests and logistic regression were used to compare outcomes. RESULTS: Among a total of 138 patients who underwent EVAR, 87% (n=119) were men with mean age of 74 years and 88% (n=122) were asymptomatic. Within the cohort, 60% (n=83) underwent GA and were more likely to have intra-operative urinary catheter placement when compared to MAC (80% versus 38%, p <0.001, respectively). POUR was identified in 14% (n=19) of the entire study population with 84% (n=16) occurring in men. POUR was not associated with elective urinary catheter placement. As expected, POUR was associated with longer hospital stay (> 1 day) compared to those without retention (58% versus 24%, p 0.002, respectively). On multivariable analysis, men who received MAC had a lower risk of developing POUR (OR 0.13; 95% CI [0.03 - 0.69]). No pre-existing conditions such as diabetes, urinary retention, benign prostatic hypertrophy (BPH), or use of BPH medications was associated with POUR. Additionally, prostate volume was not associated with developing POUR among men. CONCLUSIONS: ERAS for standard EVAR is warranted to reduce hospital stay and minimize urinary retention. GA has traditionally been employed for standard EVAR, yet MAC may be an acceptable option in some patients. We have demonstrated that MAC anesthesia decreases the incidence of POUR after EVAR in men and may be the preferred alternative among elderly men.
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