Abstract
BACKGROUND CONTEXT
Limited studies have investigated risk factors for postoperative urinary retention
(POUR) following elective spine surgery. Furthermore, some discrepancies have been
found in the results of existing observational studies.
PURPOSE
This study aimed to review the available literature on risk factors associated with
POUR following elective spine surgery.
STUDY DESIGN
A systematic review with meta-analysis was performed.
PATIENT SAMPLE
A total of 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis.
OUTCOME MEASURES
Demographics, type of elective spine surgery, country, definition of POUR, and potential
risk factors for POUR were evaluated.
METHODS
The Cochrane Library, Embase, and Medline electronic databases were searched to identify
relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean
differences (WMD) or standardized mean differences (SMD), with 95% confidence intervals
(CI), were used for meta-analysis of continuous outcomes.
RESULTS
Eleven studies (2 prospective and 9 retrospective) were included in the analysis.
Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50–9.76).
Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04–1.64).
The following variables were also identified as significant risk factors for POUR:
benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89–7.62), diabetes mellitus
(DM; OR, 1.50; 95% CI, 1.17–1.93), and previous urinary tract infection (UTI; OR,
1.70; 95% CI, 1.28–2.24). Moreover, longer operative time (WMD, 19.88; 95% CI, 5.01–34.75)
and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23–0.52) were observed
in patients with POUR. In contrast, spine surgical procedures involving fewer levels
(OR, 0.75; 95% CI, 0.65–0.86), and ambulation on the same day as surgery (OR, 0.65;
95% CI, 0.52–0.81) were associated with a decreased risk of POUR.
CONCLUSIONS
Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI
are risk factors for POUR following elective spine surgery. We also found that longer
operative time and increased intravenous fluid support would increase the risk of
POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative
voiding.
Keywords
- Postoperative urinary retention
- Spine surgery
- Elective surgery
- Risk factor
- Systematic review
- Meta-analysis Abbreviations: BPH, benign prostatic hyperplasia
- CAD, coronary artery disease
- CI, confidence Interval
- DM, diabetes mellitus
- IAP, intra-abdominal pressure
- IQR, interquartile range
- OR, odds ratio
- POUR, postoperative urinary retention
- PVR, post-void residual
- SD, standard deviation
- SMD, standardized mean differences
- UTI, urinary tract infection
- WMD, weighted mean difference
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Article info
Publication history
Published online: May 17, 2021
Accepted:
May 7,
2021
Received in revised form:
April 18,
2021
Received:
January 29,
2021
Footnotes
FDA device/drug status: approved (Vertebral body tethering).
Author disclosure: YC: Nothing to disclose. KYC: Nothing to disclose. TWT: Nothing to disclose. YSC: Nothing to disclose. PHL: Nothing to disclose. CCH: Nothing to disclose. JSL: Nothing to disclose.
Source of Funding: This work was supported by the National Cheng Kung University Hospital (NCKUH-11001004).
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