Knight B Alexander, Bayne Aaron P, Zusman Natalie, Barney Nicole, Yang Scott
Department of Urology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR, USA.
Department of Orthopaedics, Doernbecher Children's Hospital, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code CDW6, Portland, OR, 97239, USA.
Spine Deform. 2020 Aug;8(4):703-709. doi: 10.1007/s43390-020-00090-9. Epub 2020 Feb 19.
Retrospective cohort study.
This study investigates postoperative urinary retention (POUR) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and the effects of postoperative analgesia and mobility on retention. High opioid use and decreased postoperative mobility are proposed risk factors for retention in adults. There is a paucity of literature on POUR in the adolescent population undergoing surgery for AIS. The impact of pain control and mobility on POUR in these patients is unknown.
A retrospective cohort study was conducted of adolescents (11-18 years) undergoing elective PSF for AIS at a single institution (2012-2018). POUR was defined as the inability to void > 8 h after catheter removal. Possible risk factors for retention including opioid usage and ambulatory status at the time of catheter removal were assessed on univariate and binomial logistic regression analyses.
One hundred and thirty-six patients were included, with 21 (15.4%) experiencing POUR. On the day of catheter removal, 24 patients had not attempted ambulation; these patients had 2.5 times higher rate of POUR than those who were walking (30% vs. 12%, p = 0.04). Patients who developed retention ambulated a mean threefold shorter distance than those without POUR (45 vs. 136 feet, p = 0.04). On binomial logistic regression, decreased ambulation distance was associated with retention (p = 0.038). While opioid use was not significant on univariate analysis, higher opioid use on the day of catheter removal predicted retention on logistic regression (p = 0.001). POUR resolved in all patients (median duration 0.5 days, range 0-12 days).
The development of POUR after PSF for AIS affects one in six patients but resolves quickly. Non-ambulatory patients and patients who received large doses of opioids on the day of catheter removal were more likely to develop POUR.
III.
回顾性队列研究。
本研究调查青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）后发生的术后尿潴留（POUR）情况，以及术后镇痛和活动能力对尿潴留的影响。在成人中，高剂量阿片类药物使用和术后活动能力下降被认为是尿潴留的危险因素。关于接受AIS手术的青少年人群中POUR的文献较少。疼痛控制和活动能力对这些患者POUR的影响尚不清楚。
对在单一机构（2012 - 2018年）接受择期PSF治疗AIS的青少年（11 - 18岁）进行回顾性队列研究。POUR定义为拔除导尿管后8小时以上无法排尿。在单因素和二项逻辑回归分析中评估了包括阿片类药物使用和拔除导尿管时的活动状态等可能的尿潴留危险因素。
共纳入136例患者，其中21例（15.4%）发生POUR。在拔除导尿管当天，24例患者未尝试行走；这些患者发生POUR的几率是行走患者的2.5倍（30%对12%，p = 0.04）。发生尿潴留的患者行走的平均距离比未发生POUR的患者短三倍（45英尺对136英尺，p = 0.04）。在二项逻辑回归中，行走距离缩短与尿潴留相关（p = 0.038）。虽然在单因素分析中阿片类药物使用不显著，但在拔除导尿管当天使用较高剂量阿片类药物在逻辑回归中预测会发生尿潴留（p = 0.001）。所有患者的POUR均得到缓解（中位持续时间0.5天，范围0 - 12天）。
AIS患者PSF后POUR的发生率为六分之一，但缓解迅速。未行走的患者和在拔除导尿管当天接受大剂量阿片类药物的患者更易发生POUR。
III级。
