Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
Spine J. 2021 Nov;21(11):1802-1811. doi: 10.1016/j.spinee.2021.05.009. Epub 2021 May 18.
Limited studies have investigated risk factors for postoperative urinary retention (POUR) following elective spine surgery. Furthermore, some discrepancies have been found in the results of existing observational studies.
This study aimed to review the available literature on risk factors associated with POUR following elective spine surgery.
A systematic review with meta-analysis was performed.
A total of 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 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 standardized mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes.
Eleven studies (2 prospective and 9 retrospective) were included in the analysis. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50-9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04-1.64). The following variables were also identified as significant risk factors for POUR: benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89-7.62), diabetes mellitus (DM; OR, 1.50; 95% CI, 1.17-1.93), and previous urinary tract infection (UTI; OR, 1.70; 95% CI, 1.28-2.24). Moreover, 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.
Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI are risk factors for POUR following elective spine surgery. We also found that longer operative time and increased intravenous fluid support would increase the risk of POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative voiding.
仅有少数研究调查了择期脊柱手术后发生术后尿潴留（POUR）的风险因素。此外，现有观察性研究的结果存在一些差异。
本研究旨在回顾与择期脊柱手术后发生 POUR 相关的现有文献中报道的风险因素。
系统回顾和荟萃分析。
共有 31251 例患者（发生 POUR=2858 例，未发生 POUR=28393 例）纳入荟萃分析。
评估了人口统计学、择期脊柱手术类型、国家、POUR 定义以及 POUR 的潜在风险因素。
检索了 Cochrane 图书馆、Embase 和 Medline 电子数据库以确定相关研究。二元结局以比值比（OR）报告。连续结局的荟萃分析采用加权均数差（WMD）或标准化均数差（SMD），并伴有 95%置信区间（CI）。
11 项研究（2 项前瞻性和 9 项回顾性）被纳入分析。发生 POUR 的患者比未发生 POUR 的患者年龄更大（WMD，7.13；95%CI，4.50-9.76）。男性患者发生 POUR 的风险更高（OR，1.31；95%CI，1.04-1.64）。其他确定为 POUR 风险因素的变量包括良性前列腺增生症（BPH；OR，3.79；95%CI，1.89-7.62）、糖尿病（DM；OR，1.50；95%CI，1.17-1.93）和既往尿路感染（UTI；OR，1.70；95%CI，1.28-2.24）。此外，POUR 患者的手术时间更长（WMD，19.88；95%CI，5.01-34.75），术中液体支持更多（SMD，0.37；95%CI，0.23-0.52）。相比之下，脊柱手术涉及的节段较少（OR，0.75；95%CI，0.65-0.86）以及术后当天活动（OR，0.65；95%CI，0.52-0.81）与 POUR 风险降低相关。
根据我们的荟萃分析，年龄较大、男性、BPH、DM 和 UTI 史是择期脊柱手术后发生 POUR 的风险因素。我们还发现手术时间延长和静脉输液量增加会增加 POUR 的风险。此外，多节段脊柱手术可能对术后排尿产生负面影响。
