Risk factors & associated complications for postoperative urinary retention after lumbar surgery for lumbar spinal stenosis

Publication date: Available online 12 February 2018
Source:The Spine Journal
Author(s): Joshua L. Golubovsky, Haariss Ilyas, Jinxiao Chen, Joseph E. Tanenbaum, Thomas E. Mroz, Michael P. Steinmetz
Background ContextPostoperative Urinary Retention (POUR) is a very common post-operative complication of all surgeries (5 – 70%) that may lead to complications such as urinary tract infection (UTI), bladder over-distention, autonomic dysregulation, and increased postoperative length of stay (LOS). Within the field of spine surgery, the reported incidence of POUR is highly variable (5.6 – 38%). Lack of clear stratification of surgical level, spinal pathology, and inadequate sample size is a major limitation of available studies concerning POUR following spine surgery that may lead to inconsistency in the incidence of POUR and the ability to model its occurrence and consequences.PurposeThis study examines the incidence, predictive factors, and complications of POUR in patients undergoing elective posterior lumbar decompression with or without fusion for lumbar stenosis in order to eliminate bias from studying procedures done in different anatomical regions and with different approaches. Additionally, this study intends to identify the consequences of POUR.Study Design/SettingA retrospective consecutive cohort analysis was performed to examine patients undergoing posterior lumbar decompression who did and did not develop POUR.Patient SampleAll patients undergoing posterior lumbar decompression with or without fusion for lumbar stenosis with claudication from January 2014 through December 2015 at our institution were evaluated. Patients under the age of 18 and patients with spinal malignancies or infections were excluded.Outcome MeasuresPhysiological measures included identification of POUR by evidence of re-insertion of a Foley catheter, use of straight catherization post-operatively, or by a clear medical diagnosis with pharmacological treatment. Other physiological measures included identification of development of UTI, sepsis, acute kidney injury (AKI), surgical site infection, or readmission within 90 days after surgery, as well as LOS and discharge disposition.MethodsThere were no external funding sources and no authors had any conflicts of interest. The electronic medical record was searched for all patients meeting inclusion and exclusion criteria. POUR was defined as re-insertion of a Foley catheter, use of straight catherization post-operatively, or by a clear medical diagnosis with pharmacological treatment. Statistical analysis was performed in R statistical software package version 3.3.2. Multiple variable selection techniques were used to determine appropriate variables for regression models, and logistic models were fit to the development of POUR and post-operative complications, while a linear regression model was used for LOS.ResultsData was collected on 1592 consecutive patients. Among the sample population, the mean age at surgery was 67 (SD 10.1) and 45% of patients were female. The incidence of POUR was 17.1% (273/1592). Increased age (odds ratio [OR] = 1.04; 95% confidence interval [CI], 1.02 - 1.06; p < 0.001), benign prostatic hyperplasia (BPH) (OR = 1.92; 95% CI, 1.32 - 2.78); p < 0.001), previous AKI (OR = 3.29; 95% CI, 1.11 - 9.29; p = 0.025), and previous UTI (OR = 1.69; 95% CI, 1.24 - 2.24; p < 0.001) significantly increased the probability of developing POUR. Factors including increased body mass index, coronary artery disease, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, tobacco use, and fusion were found to be non-significant and were excluded from the model.With respect to complications, POUR was found to be associated with development of UTI (OR = 4.50; 95% CI, 3.14 - 6.45; p < 0.001), sepsis (OR = 4.05; 95% CI, 1.16 - 13.55; p = 0.022), increased LOS (p < 0.001), increased likelihood to be discharged to a skilled nursing facility (OR of discharge to home = 0.44; 95% CI, 0.32 – 0.62; p < 0.001), and increased risk for readmission within 90 days of the index surgery (OR = 1.60; 95% CI, 1.11 - 2.26), p = 0.009). Development of POUR did not increase the risk of developing AKI (OR = 2.45; 95% CI, 0.93 – 6.30; p = 0.063) or a surgical site infection (OR = 1.09; 95% CI, 0.56 – 2.02; p = 0.79).ConclusionsOverall, POUR was a significant risk factor for the development of UTI, sepsis, increased LOS, discharge to a skilled nursing facility, and readmission within 90 days. Surgeons and anesthesiologists should take preventative measures against POUR in individuals with increased age, BPH, and AKI and UTI within 90 days prior to surgery, as these factors were found to significantly increase the risk of POUR.



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