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Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery: Anesthetics and Surgical Approach – Lumbar Fusion

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The article investigates the relationship between postoperative urinary retention (POUR) and surgical approach and anesthetic agents in lumbar fusion surgery. The study conducted a propensity match of patients with and without POUR, controlling for various factors. The results showed that the use of succinylcholine as an induction agent and reduced postoperative activity were associated with a higher risk of POUR. Conversely, the use of sugammadex as a reversal agent was found to be protective against POUR. The study did not find a significant difference in the development of POUR between the anterior and posterior surgical approaches. Overall, the findings suggest that specific anesthetic agents and postoperative activities can impact the occurrence of POUR in lumbar fusion surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top day surgery unit in London

Published article

: We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.

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J Am Acad Orthop Surg. 2023 Sep 8. doi: 10.5435/JAAOS-D-23-00172. Online ahead of print.ABSTRACTINTRODUCTION: Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including,

J Am Acad Orthop Surg. 2023 Sep 8. doi: 10.5435/JAAOS-D-23-00172. Online ahead of print.

ABSTRACT

INTRODUCTION: Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate.

METHODS: After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis (P-value < 0.200) were performed. Significance was set to P < 0.05.

RESULTS: Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI]1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999]P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82]P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR.

: We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.

PMID:37695724 | DOI:10.5435/JAAOS-D-23-00172

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Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery: Anesthetics and Surgical Approach

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J Am Acad Orthop Surg. 2023 Sep 8. doi: 10.5435/JAAOS-D-23-00172. Online ahead of print.ABSTRACTINTRODUCTION: Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including

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