TY - JOUR
T1 - Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery
T2 - Anesthetics and Surgical Approach
AU - Heard, Jeremy C.
AU - Lee, Yunsoo
AU - Lambrechts, Mark J.
AU - Ezeonu, Teeto
AU - Dees, Azra N.
AU - Wiafe, Bright M.
AU - Wright, Justin
AU - Toci, Gregory R.
AU - Schwenk, Eric S.
AU - Canseco, Jose A.
AU - Kaye, Ian D.
AU - Kurd, Mark F.
AU - Hilibrand, Alan S.
AU - Vaccaro, Alexander R.
AU - Schroeder, Gregory D.
AU - Kepler, Christopher K.
N1 - Publisher Copyright:
© American Academy of Orthopaedic Surgeons.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Introduction:Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate.Methods:After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis (P-value < 0.200) were performed. Significance was set to P < 0.05.Results:Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI], 1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999], P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82], P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR.Conclusion:We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.
AB - Introduction:Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate.Methods:After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis (P-value < 0.200) were performed. Significance was set to P < 0.05.Results:Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI], 1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999], P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82], P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR.Conclusion:We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.
UR - http://www.scopus.com/inward/record.url?scp=85177102675&partnerID=8YFLogxK
U2 - 10.5435/JAAOS-D-23-00172
DO - 10.5435/JAAOS-D-23-00172
M3 - Article
C2 - 37695724
AN - SCOPUS:85177102675
SN - 1067-151X
VL - 31
SP - 1189
EP - 1196
JO - Journal of the American Academy of Orthopaedic Surgeons
JF - Journal of the American Academy of Orthopaedic Surgeons
IS - 23
ER -