Preventing Postoperative Urinary Retention (POUR) in Patients Undergoing Elective Lumbar Surgery: A Quality Improvement Project.

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2023-10-01 Epub Date: 2023-03-06 DOI:10.1097/QMH.0000000000000394

Jacob Jasinski, Doris Tong, Elise Yoon, Chad Claus, Evan Lytle, Clifford Houseman, Peter Bono, Teck M Soo

{"title":"Preventing Postoperative Urinary Retention (POUR) in Patients Undergoing Elective Lumbar Surgery: A Quality Improvement Project.","authors":"Jacob Jasinski, Doris Tong, Elise Yoon, Chad Claus, Evan Lytle, Clifford Houseman, Peter Bono, Teck M Soo","doi":"10.1097/QMH.0000000000000394","DOIUrl":null,"url":null,"abstract":"Background and objectives: Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS).Methods: A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant.Results: We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P = .007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P = .017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P = .015). Diabetes (OR = 2.25, CI 1.03-4.92, P = .04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P = .002) were independently associated with increased odds of developing POUR.Conclusions: After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR.","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"270-277"},"PeriodicalIF":1.2000,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quality Management in Health Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QMH.0000000000000394","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/3/6 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objectives: Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS).

Methods: A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant.

Results: We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P = .007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P = .017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P = .015). Diabetes (OR = 2.25, CI 1.03-4.92, P = .04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P = .002) were independently associated with increased odds of developing POUR.

Conclusions: After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR.

查看原文本刊更多论文

预防选择性腰椎手术患者术后尿潴留：一项质量改进项目。

背景和目的：术后尿潴留（POUR）与显著的发病率有关。在接受选择性腰椎手术的患者中，我们机构的POUR率升高。我们试图证明我们的质量改善（QI）干预将显著降低我们的POUR率和住院时间（LOS）。方法：2017年10月至2018年，在一家学术附属社区教学医院对422名患者实施了由居民主导的QI干预。这包括标准化的术中留置导管使用、术后导管插入术方案、预防性坦索罗辛和术后早期活动。从2015年10月至2016年9月，对277名患者的基线数据进行了回顾性收集。主要结果是POUR和LOS。使用焦点、分析、开发、执行和评估（FADE）模型。采用多变量分析。P值结果：我们分析了699例患者（干预前277例，干预后422例）。POUR率（6.9%vs 2.6%，Δ置信区间[CI]1.15-8.08，P=0.007）和平均LOS（2.94±1.87天vs 2.56±2.2天，ΔCI 0.066-0.68，P=0.017）在我们的干预后显著改善。Logistic回归表明，干预与POUR发生几率的显著降低独立相关（比值比[OR]=0.38，CI 0.17-0.83，P=.015）。糖尿病（OR=2.25，CI 1.03-4.92，P=.04）和较长的手术时间（OR=1.006，CI 1.002-1.01，P=.002）与POUR的发生几率的增加独立相关我们的POUR QI项目针对接受选择性腰椎手术的患者，机构POUR率显著降低4.3%（降低62%），LOS显著降低0.37天。我们证明，标准化POUR护理包与POUR发病几率的显著降低独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.