Effects of Intraoperative Anesthetic Medications on Postoperative Urinary Retention After Single-Level Lumbar Fusion

Mayo, Benjamin C.; Louie, Philip K.; Bohl, Daniel D.; Massel, Dustin H.; Iantorno, Stephanie E.; Ahn, Junyoung; Tabaraee, Ehsan; Modi, Krishna; Long, William W.; Singh, Kern

doi:10.1097/brs.0000000000001554

Cited by 22 publications

(18 citation statements)

References 16 publications

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“…The range reported in the spine literature is 5.6% to 30%. [3][4][5]7,9 In our study, POUR rates were on the higher spectrum of this range; however, it included patients who had revision surgery (48.9%) and excluded those operated at another spine region (cervical spine). In his retrospective analysis of POUR in patients undergoing elective spine surgery, Altschul et al 2 reported an incidence of POUR of 8.8%.…”

Section: Incidence Of Pourmentioning

confidence: 99%

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

Strickland

Usmani

Camacho

et al. 2020

Global Spine Journal

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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.

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Section: Incidence Of Pourmentioning

confidence: 99%

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

Strickland

Usmani

Camacho

et al. 2020

Global Spine Journal

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“…Previous research has demonstrated that intraoperative usage of phenylephrine and neostigmine may increase the risk of developing POUR. 45 Although isolated cases of POUR may resolve without serious clinical consequences, surgeons should be mindful of this complication arising in lumbar fusion procedures as a sequelae of compressive epidural hematoma resulting in cauda equina syndrome. The rate of POUR has been determined to be as high as 20% following singlelevel MIS lumbar fusion procedures.…”

Section: Postoperative Nausea and Vomitingmentioning

confidence: 99%

“…The rate of POUR has been determined to be as high as 20% following singlelevel MIS lumbar fusion procedures. 45 As increasing lumbar fusion surgeries are being performed in the ambulatory setting, essential considerations to keep in mind include the identification of risk factors that can prognosticate the development of postoperative POUR and avoiding the use of medications that may increase this risk.…”

Section: Postoperative Nausea and Vomitingmentioning

confidence: 99%

Outpatient Minimally Invasive Lumbar Fusion Using Multimodal Analgesic Management in the Ambulatory Surgery Setting

et al. 2020

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Background: The transition of minimally invasive (MIS) spine surgery from the inpatient to outpatient setting has been aided by advances in multimodal analgesic (MMA) protocols. This clinical case series of patients demonstrates the feasibility of ambulatory MIS transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) procedures while using an enhanced MMA protocol.Methods: Consecutive MIS TLIF or LLIF procedures with percutaneous pedicle screw fixation and direct decompression in the ambulatory setting were reviewed. The procedures were performed using an MMA protocol. The ambulatory surgery center (ASC) did not allow for observation of patients for periods of time greater than 23 hours. We recorded patient demographics, perioperative, and postoperative characteristics.Results: Fifty consecutive patients were identified from September 2016 to July 2019. Forty-one patients (82%) underwent MIS TLIF, and 9 patients underwent MIS LLIF (18.0%). All patients were discharged on the same day of surgery. The mean length of stay was 4.5 hours and 3.8 hours for the TLIF and LLIF cohorts, respectively. Our review of medical records revealed no postoperative complications following either the TLIF or the LLIF procedures.Conclusions: The present study of 50 consecutive patients is the largest clinical series of ASC patients undergoing lumbar fusion procedures in a stand-alone facility with no extended postoperative observation capability. While using MMA protocol within the ASC, no postoperative complications were observed for either MIS TLIF or LLIF procedures. All patients were discharged from the ambulatory surgical center on the day of surgery with well-controlled postoperative pain.Level of Evidence: 4. Clinical Relevance: The MMA protocol is an essential aspect in transitioning minimally invasive lumbar spine surgery to the ASC. Our findings indicate that MIS lumbar fusion spine surgery with an enhanced MMA protocol can lead to safe and timely ASC discharge while minimizing hospital admission.

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“…Several commonly used perioperative medications affect voiding function. Anticholinergics, volatile anesthetics, opioids, and scopolamine may contribute to detrusor underactivity via their antagonistic action on muscarinic receptors 20,24–26 . Although the authors of these studies speculate that nonsteroidal anti-inflammatory drugs may be associated with detrusor underactivity due to inhibition of prostaglandin-mediated detrusor muscle contraction, these theories are based on observational studies from other surgical subspecialties 56,121 …”

Section: Discussionmentioning

confidence: 99%

“…Studies specific to urogynecology have demonstrated that patient factors, such as medical history, prolapse stage, preexisting urinary symptoms, and preoperative urodynamic findings, are associated with POUR 16–26 . Perioperative factors, such as surgical route, concomitant procedures, surgical length, blood loss, anesthesia type, perioperative medications, intraoperative fluid management, and postoperative pain control, also may contribute to POUR 20,24–26 …”

Section: Introductionmentioning

confidence: 99%

Postoperative Urinary Retention

McDermott

Tunitsky-Bitton

Dueñas-García

et al. 2023

UROGC

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This clinical consensus statement on the management of postoperative (<6 weeks) urinary retention (POUR) reflects statements drafted by content experts from the American Urogynecologic Society's POUR writing group. The writing group used a modified Delphi process to evaluate statements developed from a structured literature search and assessed for consensus. After the definition of POUR was established, a total of 37 statements were assessed in the following 6 categories:(1) incidence of POUR, (2) medications, (3) patient factors, (4) surgical factors, (5) urodynamic testing, and (6) voiding trials. Of the 37 original statements, 34 reached consensus and 3 were omitted.

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Effects of Intraoperative Anesthetic Medications on Postoperative Urinary Retention After Single-Level Lumbar Fusion

Abstract: 4.

Cited by 22 publications

References 16 publications

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

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

Outpatient Minimally Invasive Lumbar Fusion Using Multimodal Analgesic Management in the Ambulatory Surgery Setting

Postoperative Urinary Retention

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