(I-662) Postoperative Urinary Retention (POUR) in Spinal Surgery and Considerations for Surgical Planning in the Setting of Infection and Inflammatory Disorders: A Meta-Analysis of Risk Factors

Introduction: The objective of this meta-analysis was to identify opportunities for anticipating the incidence of Postoperative Urinary Retention (POUR) in patients undergoing lumbar spinal surgery in the context of inflammatory and infectious disorders. The authors examined various associated risk factors aiming to better characterize POUR-related symptoms following spinal surgery to promote earlier intervention in alignment with improved outcomes.

Methods: The PubMed, Scopus, and Web of Science databases were queried to identify studies reporting the POUR following spinal surgery. Abstract and full-text screening of 230 initial articles returned by preliminary search yielded 4 studies for inclusion and data extraction. These included 3 case series and 1 case report. Meta-analyses were implemented through R-Studio when applicable in addition to categorical analysis via JMP. Qualitative assessments were conducted in accordance with the Newcastle-Ottawa Scale.

Results: A total of 105 patients (82 male, 23 female) were analyzed. Mean age was 40.92 ± 12.75 years. Mean operative duration was 190.89 ± 57.35 minutes. Mean estimated blood loss (EBL) was 176.141± 77.44 mL. Overall, the occurrence of POUR was 17.1 %. General complications were reported at a rate of 42.9%. Levels operated on included T12-L5, primarily in the lumbar region. Age (SMD -0.06; 95% CI, -1.01, 0.88; p=0.933) and operative duration (SMD 0.63; 95% CI, -0.21,1.47; p=0.1431) were not observed risk factors for POUR. Estimated blood loss was associated with higher risk of POUR (SMD 1.18; 95% CI, 0.31, 2.05; p=0.0080). L3-4 had a significantly lower level of association with POUR (p=0.04374).

Conclusion : This meta-analysis elucidated several potential factors possessive of utility for patients undergoing lumbar spinal surgery, particularly those with infection or inflammatory comorbidities. These included EBL and the spinal level of operation, where higher EBL was associated with increased risk of POUR. L3-4 was identified with lower occurrence of POUR, though the likelihood of coincidence due to smaller sample size suggests L3-4 specifically may not be indicative of POUR occurrence, yet operative level in general may be indicative.

How to Improve Patient Care: EBL and operative level in spinal surgery could potentially be considered when anticipating the prognosis of patients, particularly for risk of POUR.