Impact of a Bladder Scan Protocol on Discharge Efficiency Within a Care Pathway for Ambulatory Inguinal Herniorraphy

Ioana Antonescu, MD, CM, Gabriele Baldini, MD, MSc, Debbie Watson, RN, Gerald M Fried, MD, FRCSC, FACS, Kosar Khwaja, MD, MBA, MSc, FRCS, FACS, Melina C Vassiliou, MD, MED, FRCSC, Francesco Carli, MD, MPhil, FRCA, FRCPC, Liane S Feldman, MD, FRCSC, FACS

McGill University Health Centre, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation

With a reported incidence of up to 38%, post-operative urinary retention (POUR) is a common complication of ambulatory inguinal herniorraphy, and many surgeons require that their patients void prior to discharge home. The objective of this study was to assess whether the implementation of a bladder scan-based voiding protocol would improve the efficiency of discharge from the post-anesthesia care unit (PACU) without adversely affecting the rate of POUR.

As part of a perioperative care pathway, a protocol was implemented to standardize decision-making after elective inguinal hernia repair for patients who were otherwise ready for discharge but had not voided spontaneously. These patients were assessed with a bladder scan and those with less than 600cc of urine were discharged home, while those with more than 600cc had an in-and-out catheterization prior to discharge. Patients received written information about urinary symptoms and instructions to present to the emergency department if unable to void at home. We performed an audit of patients who underwent scheduled outpatient inguinal hernia repair between October 2011 and July 2012. We compared PACU stay as well as incidence of POUR before and after implementation of the protocol, in February 2012. Data are presented as means or proportions (p value), with statistical significance defined as p < 0.05.

124 patients were included, 60 prior to and 64 following implementation of the protocol. There were no significant differences in patient characteristics, laparoscopic approach (35% vs. 33%, p=0.8), proportion receiving general anesthesia (70 vs. 73%, p=0.67), or amount of intravenous fluids used (793 vs. 663 ml, p=0.07). The proportion of patients voiding prior to discharge was higher after protocol implementation (73% vs. 89%, p=0.02), including 5% of patients who had an in-and-out catheterization. The protocol had no effect on time spent in the PACU (206 vs. 229 minutes, p=0.21). After protocol implementation, PACU stay was prolonged by 68 minutes (p=0.05) for patients at high-risk for POUR (prostatic hypertrophy, previous POUR, spinal anesthesia). One patient in each group presented to the ER with POUR (2%), representing a lower incidence than that commonly reported in the literature.

After ambulatory inguinal herniorraphy, implementation of a bladder scan-based voiding protocol did not result in earlier discharge from the PACU. The incidence of POUR was lower than expected.

Session: Poster Presentation

Program Number: P605

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