(I-577) Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Elective Lumbar Spine Surgery: A Retrospective Propensity-Matched Cohort Study
Chief Resident Physician University of Florida Gainesville, Florida, United States
Introduction: Indwelling urinary catheters (IUC) are commonly placed during lumbar surgery as a presumed protection against postoperative urinary retention (POUR), one of the most common complications following this operation. Evidence in other surgical specialties suggest this to not be the case. Our objective is to investigate the effect of intraoperative catheters on POUR after lumbar surgery.
Methods: This is a single-institution, retrospective study from 06/2017-08/2019. Inclusion criteria: adult patients undergoing elective lumbar spine surgery. Exclusion criteria: emergency surgery, cauda equina/conus medullaris syndrome, infection, neoplasm, or neurodegenerative disease. Treatment arm: placement of an intraoperative IUC. Control arm: no intraoperative IUC placement. Patients were propensity-matched for age, BMI, Charlson comorbidity index, home/intraop/postop opioid use, surgical time/type, number of levels, intraoperative medication concentrations, and total fluid volume. POUR definition: bladder scan > 400 mL or any post-op bladder catheterization. Primary outcome: POUR rate. Secondary outcome: UTI rate and length of stay (LOS).
Results: Of the 1210 patients enrolled, 278 were excluded. Of the remaining 932, 190 patients were propensity-matched with 95 patients in each cohort. The median (IQR) age was 65.5 (55.5-75.5) years, 128 (67.4%) were male, 38 (20%) discectomy alone, 90 (47.4%) laminectomy, and 62 (32.6%) fusion. Surgical times ranged from 133 to 303 min. Patient characteristics, surgical characteristics, opioid use, all intraoperative medications, and fluid volumes were statistically equal between cohorts. Overall, 51 patients (26.8%) developed POUR. There was no difference in the rate of POUR between the catheter and no-catheter groups (2[28.4%] vs 23[24.2%]; P =.621). The rate of UTI was found to be higher in the catheter group (9[9.5%] vs 3[3.2%]; P =.133) and LOS was increased (3.5d vs 2.7d, P =.033). 9/95 patients (9.5%) had an indwelling catheter replaced after removal, 3/95 patients (4.2%) had one placed for POUR, and 8/12 (66.7%) went home with a Foley. There were no intraoperative bladder injuries.
Conclusion : Intraoperative urinary catheters did not reduce the risk of POUR after lumbar spine surgeries lasting 2-5 hours but did increase the risk of UTI and LOS. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered.
