Meta-analysis reveals key risk factors for postoperative urinary retention following spine surgery

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Older age, male sex, benign prostatic hyperplasia, diabetes mellitus and a history of urinary tract infection are all risk factors for postoperative urinary retention (POUR) following elective spine surgery, according to a recent meta-analysis.

The meta-analysis, the findings of which were published in The Spine Journal by Yu Chang (National Cheng Kung University Hospital, Tainan, Taiwan) et al, also found that longer operative time and increased intravenous fluid support increases the risk of POUR.

In total, 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis. Demographics, type of elective spine surgery, country, definition of POUR, and potential risk factors for POUR were all evaluated.

The Cochrane Library, Embase, and Medline electronic databases were searched to identify relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean differences (WMD) or standardised mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes.

Eleven studies—two prospective and nine retrospective—were included. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.5–9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04–1.64). In addition, benign prostatic hyperplasia (OR, 3.79; 95% CI, 1.89–7.62), diabetes mellitus (OR, 1.50; 95% CI, 1.17–1.93), and previous urinary tract infection (OR, 1.70; 95% CI, 1.28–2.24), were also identified as significant risk factors for POUR.

Furthermore, longer operative time (WMD, 19.88; 95% CI, 5.01–34.75) and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23–0.52) were observed in patients with POUR. In contrast, spine surgical procedures involving fewer levels (OR, 0.75; 95% CI, 0.65–0.86), and ambulation on the same day as surgery (OR, 0.65; 95% CI, 0.52–0.81) were associated with a decreased risk of POUR.


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