Factores de riesgo de retención urinaria aguda en cirugía mayor ambulatoria bajo anestesia espinal / Risk factors for acute urinary retention after spinal surgery

RESUMEN

Introducción: Estimar la prevalencia de retención urinaria aguda en el Programa de Cirugía mayor ambulatoria con anestesia espinal, e identificar los principales factores de riesgo para su desarrollo. Material y método: Estudio descriptivo de casos y controles. De 859 pacientes operados en programa de cirugía mayor ambulatoria entre abril 2003 y julio 2006, se seleccionaron 652 pacientes sometidos a cirugía con anestesia espinal. Los casos fueron 18 pacientes que desarrollaron retención urinaria aguda y 45 controles seleccionados al azar de los pacientes sin complicaciones en el postoperatorio. Se analizó estadística por pruebas estándares. Resultados: La prevalencia de retención urinaria aguda fue 2,76 por ciento. Se asociaron significativamente al desarrollo de retención urinaria aguda en postoperatorio las variables sexo masculino, p =0.026 OR =5.76 (IC 95 por ciento 1.17-28.24), edad sobre 50 años p =0.046 OR =3.14 (IC 95 por ciento 1.01-9.86) y cirugía hemiaria p =0.001 OR =7.59 (IC 95 por ciento 1.71-33.61). En todos los casos se manejó con cateterismo intermitente y la prolongación de estadía hospitalaria fue de un día en el 91 por ciento de los casos, y dos en el resto.

ABSTRACT

Background: The identified risk factors for acute urinary retention after spinal anesthesia are the dose and duration of anesthesia, old age and ano rectal surgical procedures. Aim: To assess the prevalence and risk factors of acute urinary retention in the program of ambulatory surgery with spinal anesthesia. Material and methods: Descriptive case control study. The medical records of 859 patients operated with spinal anesthesia between 2003 and 2006 were reviewed, and 18 patients aged 52 + 16 years, that had an acute urinary retention, were identified. Forty vive randomly chosen patients aged 46 + 14 years, without urinary retention were analyzed as controls. Results: The calculated prevalence of acute urinary retention was 2.8 percent. Male sex, an age over 50 years and hernia surgery were identified as risk factors for urinary retention with odds ratios of 5.8 (95 percent confidence interval (Cl) 17-28), 3.1 (95 percentCI 1.-9.9) and 7.6 (95 percentCI 1.7-33.6), respectively. All cases were managed with intermittent catheterization. Hospital stay was one day in 91 percent and two days in the rest. Conclusions: in this series, acute urinary retention occurred in 2.8 percent of patients after spinal surgery. Male sex, age over 50 years and hernia repair procedures were identified ads risk factors for the complication.