Faculty Bibliography

Lumbar disc herniation is a prevalent condition in the general population that can cause disabling symptoms. The treatment of lumbar disc herniation, like many conditions of the spine, has come under increased scrutiny in this era of value-based health care delivery. In response, there has been an increase in cost-effectiveness research in this area. Studies have demonstrated that surgery is cost-effective for the treatment of symptomatic lumbar disc herniation using a traditional open approach. Such research is limited for specific conservative treatment options as well as alternative surgical approaches to treating this condition, such as the minimally invasive approach.

STUDY DESIGN/METHODS:Retrospective case series. OBJECTIVE:The objectives of this study were to (1) determine the rate of postoperative urinary retention (POUR) in a series of patients undergoing lumbar spine surgery, (2) compare length of hospital stay between patients who developed POUR and patients who did not, and (3) identify the patient and surgical factors associated with the development of POUR. SUMMARY OF BACKGROUND DATA/BACKGROUND:Although POUR is a common complication in many surgical subspecialties, sparse literature is present regarding development of POUR after posterior lumbar surgical procedures. METHODS:A retrospective review was conducted of all posterior lumbar surgery cases performed at single institute from July 2008 to July 2012. Data collected included demographic variables (age, sex, body mass index), length of stay, comorbid medical conditions, and surgical data. The Wilcoxon rank sum test with continuity correction was used to compare length of hospital stay between patients who developed POUR and patients who did not. A multivariate logistic regression model was created using all patient and surgical factors and systematically pruned of variables not improving overall predictive power. RESULTS:A total of 647 patients (291 decompression, 356 decompression and fusion) were included in the study. Of 647 patients, 36 had urinary retention after lumbar spine surgery (5.6%). Patients who developed POUR had a longer length of stay than patients who did not develop POUR (3.94 d vs. 2.34 d; P=0.005). Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with development of POUR (odds ratio=3.05, 9.82, 1.04, 3.32, and 2.51, respectively). Smoking was inversely associated with the development of POUR (odds ratio=0.45). CONCLUSION/CONCLUSIONS:The risk of developing POUR after posterior lumbar spine surgery is approximately 5%. Male sex, benign prostatic hyperplasia, age, diabetes, and depression were significantly associated with the POUR group. Patients who developed POUR had a greater length of hospital stay. LEVEL OF EVIDENCE/METHODS:4.