Postoperative Urinary Retention in Patients Undergoing Elective Spine Surgery: Incidence, Risk Factors and Void Protocol

Abstract

Purpose : This study aimed to evaluate the incidence of postoperative urinary retention (POUR) in elective spine surgery patients and to identify the risk factors associated with its occurrence. Intermittent catheterization (IC) was utilized to address the POUR.

Methods: We retrospectively analyzed the demographic and clinical data of patients who underwent elective posterior spinal surgery at our institution from January 1, 2017, to February 22, 2022. Collected data included surgery duration, surgical site, volume of intraoperative fluid, length of stay, activities of daily living (ADL), and demographic characteristics. Patients with indwelling catheters or those with complete preoperative urinary retention were excluded from the study. The independent risk factors for POUR were assessed using a multivariable logistic regression model. The efficiency of the indicated factors was assessed using a random forest (RF) classifier.

Results: A total of 345 patients who were enrolled in our study met the inclusion criteria. Of them, 31 patients (9.0%) developed POUR. Male sex (OR = 0.392; 95% CI: 0.167-0.921; P = 0.032), surgery duration (OR = 1.004; 95% CI: 1.001-1.007; P = 0.014), lower surgical site (OR = 3.551; 95% CI: 1.488-8.472; p = 0.004), and admission ADL score (OR = 0.964; 95% CI: 0.949-0.979; P < 0.001) were significantly correlated with an increased incidence of POUR. RF received an area under the curve of 0.69.

Conclusions: Male sex, surgical duration, lower surgical site, and admission ADL score were independent risk factors for POUR and were effective in predicting the incidence of POUR. The identification of these risk factors may help better predict and manage voids postoperatively.

Note:
Funding Declaration: This work was funded by the Beijing Municipal Natural Science Foundation (7202150) and the National High Level Hospital Clinical Research Funding (2022-PUMCH-A019) for Yu Wang, and by the National High Level Hospital Clinical Research Funding (2022-PUMCH-B-113), the Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program (2019ZLH101), and the Beijing Municipal Natural Science Foundation (19JCZDJC64200[Z]) for Wenbin Ma.

Conflicts of Interest: None.

Ethical Approval: Approval was obtained from the Ethics Committee of Peking Union Medical College Hospital before the study was initiated (registration number 24B0264).

Keywords: postoperative urinary retention, pour, Elective Spine Surgery, risk factors, Void protocol