Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Surgery: A Review of Current Literature and Meta-Analysis

Abstract

Study Design Systematic Review and Meta-analysis Objective Postoperative urinary retention (POUR) is a common complication following lumbar spine surgery (LSS) and timely recognition is imperative to avoid long-term consequences. The aim of the current meta-analysis was to systematically review the literature in order to identify risk factors associated with POUR after LSS. Methods In accordance with PRISMA guidelines, a systematic review of the literature was performed using Pubmed, EMBASE, and MEDLINE database for articles on POUR following LSS. A meta-analysis was performed comparing patients with and without POUR; and the factors associated with this adverse event were analyzed. The pooled data were reported as mean differences with 95% confidence intervals (CI; P < .05). Heterogeneity among the studies was evaluated using the I2 statistic. Results The meta-analysis included 10 studies compromised of 30,300 patients. Based on our analysis, patients who were male, were older in age, underwent instrumented fusion, had diabetes mellitus, coronary artery disease, or benign prostatic hypertrophy had significantly higher risk of developing POUR. Additionally, patients in who developed POUR had significantly longer surgical times and higher volumes of intra-operative fluid administration, as compared with non-POUR patients. The POUR patients also had a significantly higher association with urinary tract infection. Prior surgery, BMI, length of stay, and smoking status did not reveal any statistical association with POUR. Conclusions Risk factors associated with POUR following LSS include male gender, older age, longer surgical times, fusion procedures, larger volumes of intraoperative infusions, and associated comorbidities like DM, CAD, and BPH.

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“…Urinary retention is a common complication after lumbar surgery, which may be quite painful for patients, and it further increases the risk of infection because a few patients need to insert catheters for a long time because of urinary retention. [ 12 , 13 ] For patients with long-term indwelling sterile catheter, the drainage tube should be opened once every 4–6 hours, and bladder irrigation should be carried out twice a day with sterile injection water or boric acid solution to prevent infection. When patients stay in bed for a long time, family members and medical staff need to help patients turn over, pat their backs and move their paralyzed limbs passively, which can effectively prevent pressure ulcers, falling pneumonia and deep venous thrombosis of lower limbs and promote the recovery of patients’ condition.…”