Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA.
Department of Anesthesia, Tufts Medical Center, Boston, MA, USA.
Clin Neurol Neurosurg. 2022 Nov;222:107454. doi: 10.1016/j.clineuro.2022.107454. Epub 2022 Sep 27.
Postoperative urinary retention (POUR) is a common and vexing complication in elective spine surgery. Efficacious prevention strategies are still lacking, and existing studies focus primarily on identifying risk factors. Spinal anesthesia has become an attractive alternative to general anesthesia in elective lumbar surgery, with the potential of having a differential impact on POUR.
422 spinal anesthesia procedures were prospectively collected between 2017 and 2021 and compared to 416 general anesthesia procedures retrospectively collected between 2014 and 2017, at a single academic center by the same senior neurosurgeon. The main outcome was POUR, defined as the need for straight bladder catheterization or indwelling bladder catheter placement after surgery due to failure to void. A power calculation was performed prior to data collection.
The general anesthesia group had a higher rate of POUR (9.1 %) compared with the spinal anesthesia group (4.3 %), p = 0.005. At baseline, the spinal anesthesia cohort had an older average age and fewer patients with a history of previous spine surgery. Other comorbid conditions were comparable between the groups. For perioperative characteristics, spinal anesthesia patients had higher ASA scores, shorter operative times, shorter lengths of hospital stay, less operative levels, and zero use of intraoperative bladder catheterization. Acute pain service consult was similar between the groups. A multivariable logistic regression revealed that spinal anesthesia was associated with a significantly lower rate of urinary retention in the spinal anesthesia group (p = 0.0130), after adjusting for potentially confounding factors. Other statistically significant risk factors for POUR included diabetes, (p = 0.003), BPH (p = 0.014), operative time (p = 4.94e-06), and ASA score (p = 0.005).
We collect and analyze one of the largest available cohorts of patients undergoing simple and complex surgeries under spinal and general anesthesia, finding that spinal anesthesia is independently associated with a lower incidence of POUR compared to general anesthesia, even when adjusted for potentially confounding risk factors. Further prospective trials are needed to explore this finding.
术后尿潴留（POUR）是择期脊柱手术中常见且令人困扰的并发症。目前仍缺乏有效的预防策略，现有研究主要集中在识别风险因素上。椎管内麻醉已成为择期腰椎手术中全身麻醉的一种有吸引力的替代方法，其对 POUR 的影响可能存在差异。
2017 年至 2021 年期间，在一家学术中心，同一位资深神经外科医生前瞻性收集了 422 例椎管内麻醉手术，并与 2014 年至 2017 年期间回顾性收集的 416 例全身麻醉手术进行比较。主要结局为 POUR，定义为手术后因无法排尿而需要进行直式膀胱导尿或留置导尿。在数据收集之前进行了功率计算。
全身麻醉组 POUR 发生率（9.1%）高于椎管内麻醉组（4.3%），p=0.005。在基线时，椎管内麻醉组的平均年龄较大，且有既往脊柱手术史的患者较少。两组的其他合并症相似。对于围手术期特征，椎管内麻醉患者的 ASA 评分较高，手术时间较短，住院时间较短，手术节段较少，术中无一例使用膀胱导尿管。两组急性疼痛服务咨询情况相似。多变量逻辑回归显示，调整潜在混杂因素后，椎管内麻醉与椎管内麻醉组 POUR 发生率显著降低相关（p=0.0130）。其他与 POUR 相关的统计学显著风险因素包括糖尿病（p=0.003）、BPH（p=0.014）、手术时间（p=4.94e-06）和 ASA 评分（p=0.005）。
我们收集并分析了接受椎管内和全身麻醉下进行简单和复杂手术的患者中最大的可用队列之一，发现与全身麻醉相比，椎管内麻醉与 POUR 发生率较低独立相关，即使在调整了潜在的混杂风险因素后也是如此。需要进一步的前瞻性试验来探讨这一发现。
