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- Title
Factors Influencing Post-Operative Urinary Retention Following Elective Lumbar Spine Surgery - A Prospective Study.
- Authors
Aiyer, Siddharth; Kumar, N. Ajit; Kanna, Rishi Mugesh; Shetty, Ajoy; Rajasekaran, S.
- Abstract
Introduction: Postoperative urinary retention (POUR) following elective lumbar spine surgery can lead to prolonged hospital stay and increased morbidity. POUR often requires catheterisation thereby increasing the risk of urinary tract infections, catheter related complications and sepsis. The incidence and risk factors associated with POUR in lumbar spine surgery have not been well established.Recommendations for urinary catheterization in the perioperative setting vary widely and areinfluenced by numerous factors including surgical procedure, type of anaesthesia, co-morbidities, local policies, and personal preferences. The aim of the study was to determine the incidence of POUR in patients undergoing elective posterior lumbar spine surgery and to identify risk factors associated with development of POUR. Material and Methods: A prospective, consecutive analysiswas conducted in patients that underwent elective posterior lumbar surgery in the form of lumbar discectomy, lumbar decompression and single level lumbar fusions duringa six monthperiod. Patients with acute spine trauma, preoperative neurological deficit, history of previous urinary disturbance/symptoms, multiple level fusion and, those catheterized pre-operatively were excluded from the study. The patients that developed POUR (group A) were assessed for possible risk factors and compared with patients that did not develop any urinary retention (group B) during the study period.The patients with POUR were compared with the group without POUR during the study period to assess the risk factors. Univariate analysis and a multiple logistical regression analysis were performed. Results: A total of 687patients were operated for elective lumbar spine surgeryduringthestudyperiod. Based on the inclusion and exclusion criteria 370 patients were included in the final analysis. There were 61 patients that developed POUR and 309 patients formed the control group. Only one patient was discharged with an indwelling urinary catheter which was removed at 3 weeks. In the univariate analysis, significant risk factors for POUR were older age (p = 0.03); higher BMI (< 0.0001); longerduration of surgery (p < 0.0001); largervolumeofintraoperativefluid administration (p < 0.001); surgical procedure of lumbar fusion versus discectomy/decompression (p = 0.001) and higher postoperative pain scores (p < 0.0001). Factors which did not show a significant association included sex (p = 0.54); diabetes (p = 0.06); type of inhalational agent used during anaesthesia (p = 0.2) (Isoflurane versus Sevoflurane). A multiple logistical regression analysis including age, BMI, duration of surgery, intraoperative fluid administration, type of surgical procedure and postoperative pain scores showed apredictive value of 93% overall and 97% in the POUR group. Conclusion: The occurrence of POUR was associated with older age, higher BMI, longer duration of surgery, larger volume of intraoperative fluid administration and higher postoperative pain scores. The multiple logistical regression analysis showed significant contribution of post operative pain scores in the prediction of POUR. This suggests that adequate pain relief in the post operative period is a key factor which can help prevent POUR.
- Publication
Global Spine Journal, 2018, Vol 8, p170S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/2192568218771030