The preoperative risks and 2-year sequelae of postoperative urinary retention: analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC).

October 3, 2019

OBJECTIVE:

While postoperative urinary retention (POUR) is common after spine surgery, the association of this adverse event with other morbidities and patient-reported outcomes is not fully understood. We sought to examine the sequelae of POUR after lumbar spine surgery.

METHODS:

The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a large, prospective, multicenter registry. MSSIC was queried with multivariate analysis for factors that are associated with POUR, the association of POUR with 90-day adverse events, and the effect of POUR on 2-year patient-reported outcomes and satisfaction.

RESULTS:

Multivariate analysis identified hardware revision (OR0.61), one operative level (OR0.74), and ambulation on postoperative day zero (OR0.65) to be protective for POUR. Factors associated with POUR included age (OR1.19), male gender (OR1.58), body mass index <25 (OR1.22), diabetes (OR1.28), coronary artery disease (OR1.20), fusion surgery, (OR1.27) and longer surgery (OR1.11). Patients who had POUR were more likely to be readmitted, develop a urinary tract infection, and develop an infection (P<0.001). POUR was associated with decreased likelihood of achieving Oswestry Disability Index minimal clinically important difference (MCID) at 90d (P<0.001), but not at 1 year after surgery. POUR was associated with dissatisfaction with surgery at 90d (P<0.001), 1-year (P=0.004), and 2-years post-surgery (P=0.011).

CONCLUSIONS:

POUR is common after lumbar spine surgery, and the demographic, diagnostic, and surgical factors that are associated with POUR are identified. POUR is associated with several adverse events, and patients who have POUR were less likely to be satisfied with surgery up to 2 years post surgery.