Postoperative Urinary Retention Following Thoracolumbosacral Spinal Fusion: Prevalence, Risk Factors, and Outcomes.

Cheryl Marise Peilin Tan,Glen Wen Kiat Ho,Jacob Yoong-Leong Oh,Arun-Kumar Kaliya-Perumal

doi:10.7759/cureus.19724

Abstract

ObjectivePostoperative urinary retention (POUR) is an often-underestimated common complication following spine surgery, and it is essential to avoid its untoward long-term consequences. Besides, a dilemma exists regarding the appropriate timing for the postoperative removal of indwelling catheter (IDC). Hence, we aim to describe the prevalence, risk factors, and outcomes of POUR and also come up with recommendations for the removal of IDC.MethodsElectronic records of patients who underwent elective thoracolumbosacral spinal fusion surgery from January 2017 to December 2019 were retrospectively reviewed. Excluded were those who underwent fusion for indications such as trauma, cauda equina syndrome, infection, and malignancy. Both surgery-related and patient-related risk factors were tabulated, and their association with the likely development of POUR was assessed by univariate and multivariate analysis.ResultsOne hundred sixty-eight patients (median age=64.1 years; 58.9% female) were included, with the incidence of POUR being 7.8%. Our findings suggest surgery-related factors, both intra- and postoperative, including operating time (p=0.008), anesthetic time (p=0.005), number of fusion levels (p<0.001), mobilization status prior to trial off catheter (TOC; p=0.021), and TOC timing (p=0.029) may have an association with POUR. In addition, patient-related factors, including the use of beta-blockers (p=0.020) and pre-operative mobility status (p<0.001), may also be associated with the likely development of POUR.ConclusionPOUR seems to be a frequent complication following thoracolumbosacral spinal fusion surgery, which was found to have an association with some surgery-related and patient-related factors. While most of these factors are non-modifiable, certain modifiable risk factors provide the surgeon an opportunity to prevent POUR. Considering these factors, we recommend appropriate and timely mobilization of the patient prior to removal of IDC, which is to be performed preferably in the daytime.

Highlights

Postoperative urinary retention (POUR) can be defined as the inability to void urine during the postoperative period despite a painful and distended bladder that is filled to capacity [1]
Our findings suggest surgery-related factors, both intra- and postoperative, including operating time (p=0.008), anesthetic time (p=0.005), number of fusion levels (p
While most studies only report the routine placement of indwelling catheter (IDC) during surgery, there is no clear consensus on the timing of its removal [7,8,12]

Summary

Introduction

Postoperative urinary retention (POUR) can be defined as the inability to void urine during the postoperative period despite a painful and distended bladder that is filled to capacity [1]. It is a relatively common complication following surgical procedures and causes discomfort [2], problems such as urinary tract infection [3], detrusor overdistention and damage [4], and increased postoperative length of hospital stay [5]. The reported incidence of POUR following spinal surgery ranges between 5.6% and 39.4% [5,6,7,8,9,10,11,12,13,14]. In general, it is considered that early removal of IDC may lead to POUR, while removing it late may pose a higher risk for

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Conclusion