Spine Research Fellow Hospital for Special Surgery Hospital for Special Surgery
Disclosure(s):
Cole Kwas, BA: No financial relationships to disclose
Introduction: Postoperative urinary retention, or POUR, a common complication after spine surgery, can contribute to longer hospital stays, urinary tract infection, and long-term detrusor damage due to bladder overdistension. The aim of this study was to determine the incidence and risk factors of POUR in patients who underwent lumbar decompression and construct a predictive model for preoperatively identifying high-risk patients.
Methods: This was a retrospective review of patients undergoing primary lumbar decompression from 2017 to 2023 at a single institution. Demographics, comorbidities, and perioperative data were collected. Factors associated with POUR were assessed, and multivariate logistic regressions were performed to identify independent predictors for the development of POUR. Youden’s Index was used to find the optimal cutoff for continuous variables. A nomogram to predict the development of POUR was developed within a training subset based on a multivariate logistic regression model of preoperative variables, followed by the internal validation of the model in a validation subset.
Results: Of the 1,938 patients included in this study, 133 (6.9%) developed POUR. Following multivariate analysis, the following risk factors for POUR were identified: history of urinary retention (p < 0.001, OR=4.255, 95% CI=1.833-9.614), non-commercial/private insurance, (p=0.002, OR=2.443, 95% CI=1.396-4.275), intraoperative Foley catheter use (p < 0.001, OR=5.020, 95% CI=3.100-8.129), inpatient opioid consumption >93 MME (p=0.015, OR=1.686, 95% CI=1.105-2.574), and anticholinergic medication use during hospitalization (p < 0.001, OR=3.473, 95% CI=2.336-5.162). The nomogram, which included the preoperative variables of male sex, age >65, history of urinary retention, history of BPH, non-commercial insurance, and ASA Class >2, demonstrated good discrimination in the training (AUC= 0.725, 95% CI=0.673-0.776) and validation (AUC=0.709, 95% CI=0.599-0.819) subsets. The Hosmer-Lemeshow goodness-of-fit test demonstrated the model fit the data well (χ2=9.063, p=0.170).
Conclusion : The incidence of POUR after lumbar decompression surgery was found to be 6.9%. Demographic and perioperative variables associated with increased risk of POUR were identified. Furthermore, we constructed a preoperative predictive model with good performance metrics to help clinicians identify patients at special risk for developing POUR. Ideally, this user-friendly tool could assist providers in preoperatively anticipating downstream urinary retention and modifying the perioperative care of their patients accordingly.