Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;11(3):338-344.
doi: 10.1177/2192568220904681. Epub 2020 Feb 26.

Evaluation of Risk Factors for Postoperative Urinary Retention in Elective Thoracolumbar Spinal Fusion Patients

Ashley R Strickland  1 , M Farooq Usmani  1 , Jael E Camacho  1 , Amil Sahai  1 , Jacob J Bruckner  1 , Kendall Buraimoh  1 , Eugene Y Koh  1 , Daniel E Gelb  1 , Steven C Ludwig  1
Affiliations

Evaluation of Risk Factors for Postoperative Urinary Retention in Elective Thoracolumbar Spinal Fusion Patients

Ashley R Strickland et al. Global Spine J. 2021 Apr.

Abstract

Study design: Retrospective case series.

Objectives: Postoperative urinary retention (POUR) represents a common postoperative complication of all elective surgeries. The aim of this study was to identify demographic, comorbid, and surgical factors risk factors for POUR in patients who underwent elective thoracolumbar spine fusion.

Methods: Following institutional review board approval, patients who underwent elective primary or revision thoracic and lumbar instrumented spinal fusion in a 2-year period in tertiary and academic institution were reviewed. Sex, age, BMI, preoperative diagnosis, comorbid conditions, benign prostatic hyperplasia, diabetes, primary or revision surgery status, narcotic use, and operative factors were collected and analyzed between patients with and without POUR.

Results: Of the 217 patients reviewed, 54 (24.9%) developed POUR. The average age for a patient with POUR was 67 ± 9, as opposed to 59 ± 10 for those without (P < .0001). Single-level fusions were associated with a 0% incidence of POUR, compared with 54.5% in 6 or more levels. The average hospital stay was increased by 1 day for those who had POUR (5.8 ± 3.3 vs 4.9 ± 3.9 days). There was no significant association with other demographic variables, comorbid conditions, or surgical factors.

Conclusions: POUR was a common complication in our patient cohort, with an incidence of 24.9%. Our findings demonstrate that patients who developed POUR are significantly older and have larger constructs. Patients who developed POUR also had longer in-hospital stays. Although our study supports other findings in the spine literature, more prospective data is needed to define diagnostic criteria of POUR as well as its management.

Keywords: degenerative; length of stay; low back pain; lumbar; narcotic use; postoperative complication; urinary retention.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Gelb is a board member and fellowship committee chair for AOSpine NA. He receives payment for lectures and for development of educational presentations from AOSpine NA. He receives royalties from DePuy Synthes Spine and Globus Medical. He has stock in the American Society for Investigative Pathology. Dr Koh receives payment for consultancy from Biomet. His institution receives RO1 grant money from the National Institutes of Health. Dr Ludwig is a board member for Globus Medical, the American Board of Orthopaedic Surgery, the American Orthopaedic Association, the Cervical Spine Research Society, and the Society for Minimally Invasive Spine Surgery. He is a paid consultant for DePuy Synthes, K2M, and Globus Medical. He receives payment for lectures and travel accommodations from DePuy Synthes and K2M. He receives payment for patents and royalties from DePuy Synthes and Globus Medical. He has stock in Innovative Surgical Designs and the American Society for Investigative Pathology. He receives research support from AO Spine North America Spine Fellowship support, Pacira Pharmaceutical, and AOA Omega Grant. He is a board member of Maryland Development Corporation. He receives royalties from Thieme, Quality Medical Publishers. He is on the governing board of Journal of Spinal Disorders and Techniques, The Spine Journal, and Contemporary Spine Surgery. The authors have no further potential conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Patient inclusion and exclusion into the study. A total of 586 patients were identified from the database and 217 were included in the study. Abbreviations: EMR, electronic medical record; ESRD, end-stage renal disease.
Figure 2.
Figure 2.
Foley catheter removal protocol: after 2 I&O catheterizations, the Foley catheter is reinserted and the patient is started on tamsulosin. Abbreviations: I&O, in and out; TOV, trial of void; PVR, postvoid residual scan; DRE, digital rectal examination.
See this image and copyright information in PMC

References

    1. Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009;110:1139–1157. - PubMed
    1. Altschul D, Kobets A, Nakhla J, et al. Postoperative urinary retention in patients undergoing elective spinal surgery. J Neurosurg Spine. 2017;26:229–234. - PubMed
    1. Gandhi SD, Patel SA, Maltenfort M, et al. Patient and surgical factors associated with postoperative urinary retention after lumbar spine surgery. Spine (Phila Pa 1976). 2014;39:1905–1909. - PubMed
    1. Golubovsky JL, Ilyas H, Chen J, Tanenbaum JE, Mroz TE, Steinmetz MP. Risk factors and associated complications for postoperative urinary retention after lumbar surgery for lumbar spinal stenosis. Spine J. 2018;18:1533–1539. - PubMed
    1. Lee S, Kim CH, Chung CK, et al. Risk factor analysis for postoperative urinary retention after surgery for degenerative lumbar spinal stenosis. Spine J. 2017;17:469–477. - PubMed

LinkOut - more resources