Merritt Denham, BS, Kara Donovan, BS, Nicole Wetoska, Kristine Kuchta, MS, JoAnn Carbray, BS, John G Linn, MD, Woody Denham, MD, Stephen P Haggerty, MD, FACS, Michael Ujiki, MD, FACS. NorthShore University Health System
Introduction: Post-operative urinary retention (POUR) is a complication of Laparoscopic Inguinal Hernia Repair (LIHR). Previous research has examined predictive perioperative factors of POUR, with several studies pointing to age and presence of benign prostatic hyperplasia (BPH) as significant factors. But there is currently limited work on preventative measures for POUR. We hypothesize that dexamethasone, a steroid, reduces the rate of urinary retention following LIHR due to its mechanism.
Methods: Consecutive patients (n=955) undergoing LIHR from 2009-2017 at a single institution were selected from a prospectively managed database. All procedures were performed by four general surgeons. Only male patients were selected, as the vast majority of urinary retention complications occur in males. These patients were retroactively chart reviewed and divided into two groups, dexamethasone use (n=617) and no dexamethasone use (n=338). Perioperative factors were compared between groups with chi-square and independent samples t-tests. Univariable and multivariable logistic regression analysis was used to assess whether dexamethasone use was associated with POUR. A subgroup analysis was performed on the dexamethasone group, to determine if there was a dose-dependent effect.
Results: Our study showed a significant difference in POUR between the dexamethasone group and no dexamethasone group (3.7% vs. 9.8%, p=.0001). Patients in the dexamethasone group had a shorter length of stay, and were less likely to have BPH or a foley placed (all p<.05). Age and BMI were similar between groups. Multivariable analysis showed the use of dexamethasone was associated with a reduced risk of POUR (OR=0.52, 95% CI: 0.2-0.97, p=0.0386), while controlling for other factors such as age and presence of BPH. A subgroup analysis examined the effect of dexamethasone per unit (mg) increase. There was no significant association between dexamethasone dose and POUR rates (OR=1.07, 95% CI 0.82-1.38, p=0.6241).
Discussion: In this retrospective review of 955 patients, those who received dexamethasone showed a significantly lower rate of POUR regardless of dose. These results suggest that dexamethasone can be administered to reduce POUR in males undergoing laparoscopic inguinal hernia repair.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88428
Program Number: S006
Presentation Session: Hernia Session
Presentation Type: Podium