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Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis

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Abstract

Study design

Retrospective cohort study.

Objectives

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.

Summary of background data

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.

Methods

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.

Results

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).

Conclusions

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.

Level of evidence

III.

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Funding

No funding was received for this work.

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Authors and Affiliations

  1. Department of Urology, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR, USA

    B. Alexander Knight & Aaron P. Bayne

  2. 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

    Natalie Zusman, Nicole Barney & Scott Yang

Authors
  1. B. Alexander Knight
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  2. Aaron P. Bayne
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  3. Natalie Zusman
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  4. Nicole Barney
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  5. Scott Yang
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Contributions

BAK: substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; drafting the work; final approval of the version to be published. APB: substantial contributions to the conception and design of the work; the analysis and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published. NZ: substantial contributions to the acquisition and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published. Nicole Barney: substantial contributions to the acquisition and interpretation of data for the work; revising the work critically for important intellectual content; final approval of the version to be published. SY: substantial contributions to the conception and design of the work; the analysis and interpretation of data for the work; revising the critically for important intellectual content; final approval of the version to be published.

Corresponding author

Correspondence to Scott Yang.

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Knight, B.A., Bayne, A.P., Zusman, N. et al. Postoperative management factors affect urinary retention following posterior spinal fusion for adolescent idiopathic scoliosis. Spine Deform 8, 703–709 (2020). https://doi.org/10.1007/s43390-020-00090-9

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  • DOI: https://doi.org/10.1007/s43390-020-00090-9

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