P18. Preoperative lower urinary tract symptoms and subsequent risk of postoperative urinary retention after elective spinal fusion surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> The prevalence of lower urinary tract symptoms (LUTS) in patients undergoing elective spine surgery has been reported to be about 40%. However, there has been no study examining the relationship between preoperative LUTS and the risk of postoperative urinary retention (POUR) in this patient population. <h3>PURPOSE</h3> Among adult patients undergoing elective spinal fusion, we determined the extent to which the risk of POUR was elevated among patients with LUTS compared to patients without LUTS. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort study. <h3>PATIENT SAMPLE</h3> All patients ≥ 18 years of age undergoing elective spinal fusion surgery at an academic medical center between July 2017 and March 2020 were evaluated. <h3>OUTCOME MEASURES</h3> POUR was identified by documentation of a Foley or straight catheter insertion between the time of anesthesia stop and admission discharge. <h3>METHODS</h3> Patients completed the validated 7-item International Prostate Symptom Score (IPSS) (score range 0-35 points) at their preoperative visit. The IPSS is appropriate for assessing LUTS severity in both men and women. Clinically relevant LUTS are defined as an IPSS score ≥ 8 points. Patient medical records were searched for the insertion of a Foley or straight catheter during the postoperative period and several potential confounding variables including age, sex and intraoperative Foley catheter use. The analytic sample was restricted to patients who completed a preoperative IPSS, underwent surgery, and were discharged ≥ 8 hours after surgery. The association of LUTS and risk of POUR was estimated with risk ratios (RR) and 95% confidence intervals (CI) from a multivariable Poisson regression with a robust variance estimate adjusted for potential confounding variables. <h3>RESULTS</h3> A total of 456 patients were included in the analytic cohort with 296 (61% women) undergoing lumbar fusion and 160 (62% women) undergoing cervical fusion. The means (standard deviation) of age were 63.2 (11.5) and 57.0 (11.9) among the lumbar fusion and the cervical fusion patients, respectively. Preoperative LUTS prevalence was comparable among the two groups of patients defined by location of fusion: 53% among those undergoing lumbar fusion and 58% among those undergoing cervical fusion. For lumbar fusion, 16 (12%) of 139 without LUTS and 25 (16%) of 157 with LUTS developed POUR. In cervical fusion patients, 3 (4%) of 68 without LUTS and 11 (12%) of 92 with LUTS developed POUR. Among all patients undergoing either type of fusion surgery, the unadjusted RR was 1.6 (95% CI: 0.9, 2.7) (P = 0.09). Adjustment for location of fusion (lumbar, cervical), age, sex and intraoperative Foley catheter use did not materially alter this association: the multivariable RR was 1.6 (95% CI: 0.9, 2.6) (P = 0.10). Although positive associations were observed, they were of borderline statistical significance. <h3>CONCLUSIONS</h3> Among adults undergoing lumbar or cervical fusion surgery, those with LUTS at the preoperative visit appear to be at higher risk of developing POUR. Improper or delayed management of POUR can lead to several complications including urinary tract infection and increased length of stay. These results suggest that routinely assessing preoperative LUTS in patients undergoing elective spinal fusion surgery could help identify those at higher risk of developing POUR. Early identification of these patients could allow prophylactic measures against POUR complications to be implemented. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.