Postoperative urinary retention after spinal fusion for adolescent idiopathic scoliosis: effects of opioids and mobility
Brent A. Knight, MD, Scott Yang, MD, Aaron Bayne, MD.
Oregon Health and Science University, Portland, OR, USA.
BACKGROUND: Postoperative urinary retention (POUR) affects up to one-quarter of adult patients undergoing spine surgery, with high narcotic use and decreased postoperative mobility as possible risk factors. Scarce literature exists on POUR among patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF), a surgery associated with significant pain and prolonged convalescence. We investigated the incidence of and risk factors for POUR in this patient population.METHODS: A retrospective cohort study was conducted of adolescents (10-18 years) undergoing elective PSF for AIS at a single institution (January 2012 - September 2018). POUR was defined as the inability to void > 8 hours after catheter removal with a post-void residual volume > 100% of expected bladder capacity. Possible risk factors for retention (patient characteristics, surgical factors, and postoperative course including daily opioid usage and ambulatory status at time of catheter removal) were assessed.RESULTS: One hundred and thirty-six patients were included in the cohort. Twenty-one (15.4%) patients developed POUR. Patients with POUR had greater mean estimated blood loss, greater mean operative time, and greater mean intraoperative fluid use than those without POUR (Table). Patients with POUR were less likely to have ambulated, and among those who were mobile, POUR patients ambulated a mean three-fold shorter distance than those without POUR (Table). Mean opioid consumption did not differ between the groups (Table). On logistic regression, ambulated distance (odds ratio (OR) = 0.75 per fifty feet ambulated, 95% confidence interval (CI) 0.57, 0.98) and intraoperative fluid (OR = 1.82 per liter of fluid, 95% CI 1.14, 2.92) were independent predictors of POUR. Median time to return to normal voiding was 1 day (range 0 –12).CONCLUSIONS: One in six patients developed POUR after AIS repair. This is the first study to suggest a relation between POUR and activity level following AIS surgery. Development of POUR after AIS repair is likely multifactorial, but judicious use of intraoperative fluids and consideration of an accelerated postoperative ambulatory advancement pathway may target the findings in this study. Both spine surgeons and consulting urologists can use this information to help guide treatment for patients following spinal surgery.
|Variable||No Urinary Retention|
(n = 115)
(n = 21)
|Age (year)||14.9 ± 2.2||15.1 ± 2.2||0.72|
|Weight (kg)||59.2 ± 16.5||55.7 ± 13.9||0.35|
|Intraoperative fluids (L)||3.4 ± 1.0||4.1 ± 1.1||0.004|
|Estimated blood loss (mL)||608 ± 272||776 ± 411||0.02|
|Operative duration (minutes)||232 ± 61||264 ± 63||0.03|
|Major Cobb angle (o)||56.4 ± 10.6||59 ± 12.1||0.33|
|Number of fusion levels||10.2 ± 1.2||10.0 ± 1.7||0.38|
|Postoperative day Foley removed||2.5 ± 0.8||2.6 ± 0.9||0.79|
|Morphine equivalent dose* (mg)||42 ± 30||46 ± 36||0.59|
|Cumulative morphine equivalent dose* (mg)||146 ± 117||106 ± 60||0.14|
|Ambulatory activity status* (%): |
|Ambulation distance* (feet)||136 ± 15||45 ± 90||0.02|
*On day of catheter removal
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