Golubovsky JL, et al. - Herein, the authors evaluated the incidence, predictive factors, and complications of Postoperative Urinary Retention (POUR) in individuals who underwent elective posterior lumbar decompression with or without fusion for lumbar stenosis for eliminating the prejudice from studying procedures done in different anatomical regions and with different approaches. They also assessed the consequences of POUR. Findings revealed that for the development of urinary tract infection (UTI), sepsis, increased length of stay (LOS), discharge to a skilled nursing facility, and readmission within 90 days, POUR was a significant risk factor. Preventative measures ought to be taken against POUR by the surgeons and anesthesiologists in patients with increased age, benign prostatic hyperplasia (BPH), and acute kidney injury (AKI) and UTI within 90 days before the surgery, as these factors notably increased the risk of POUR.

Methods

• Experts conducted a retrospective consecutive cohort analysis in order examine the cases who underwent posterior lumbar decompression that did and did not present with POUR.
• Individuals subjected to posterior lumbar decompression with or without fusion for lumbar stenosis with claudication were enrolled from January 2014 through December 2015.
• Herein the researchers excluded patients under the age of 18 and those with spinal malignancies or infections.
• Physiological measures consisted of identification of POUR by evidence of re-insertion of a Foley catheter, use of straight catherization post-operatively, or by a clear medical diagnosis with pharmacological treatment. 
• Other physiological measures constituted the identification of development of UTI, sepsis, acute kidney injury (AKI), surgical site infection, or readmission within 90 days after surgery, as well as LOS and discharge disposition.
• No external funding sources were noted and no authors had any conflicts of interest.
• A search was carried out of the electronic medical record for all patients meeting inclusion and exclusion criteria.
• POUR was defined as re-insertion of a Foley catheter, use of straight catherization post-operatively, or by a clear medical diagnosis with pharmacological treatment.
• Statistical analysis was performed in R statistical software package version 3.3.2.
• In order to determine appropriate variables for regression models, and logistic models were fit to the development of POUR and post-operative complications, multiple variable selection techniques were used and a linear regression model was used for LOS.

Results

• The data was obtained of 1,592 cases.
• The mean age at surgery was 67 (SD 10.1) and 45% of patients were female.
• The POUR incidence was noted to be 17.1% (273/1592).
• The probability of developing POUR was notably increased due to increased age (odds ratio [OR] = 1.04; 95% confidence interval [CI], 1.02 - 1.06; p < 0.001), benign prostatic hyperplasia (BPH) (OR = 1.92; 95% CI, 1.32 - 2.78); p < 0.001), previous AKI (OR = 3.29; 95% CI, 1.11 - 9.29; p=0.025), and previous UTI (OR = 1.69; 95% CI, 1.24 - 2.24; p < 0.001).
• Authors noted that increased body mass index, coronary artery disease, congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, tobacco use, and fusion were non-significant factors and hence were excluded from the model.
• Regarding the complications, POUR was seen to be associated with development of UTI (OR = 4.50; 95% CI, 3.14 - 6.45; p < 0.001), sepsis (OR = 4.05; 95% CI, 1.16 - 13.55; p=0.022), increased LOS (p < 0.001), increased likelihood to be discharged to a skilled nursing facility (OR of discharge to home = 0.44; 95% CI, 0.32 – 0.62; p < 0.001), and increased risk for readmission within 90 days of the index surgery (OR = 1.60; 95% CI, 1.11 - 2.26), p=0.009).
• The risk of developing AKI (OR = 2.45; 95% CI, 0.93 – 6.30; p=0.063) or a surgical site infection (OR = 1.09; 95% CI, 0.56 – 2.02; p=0.79) was not increased due to the development of POUR.