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Wang SK, Wang P, Li ZE, Li XY, Kong C, Lu SB. Development and external validation of a nomogram for predicting postoperative adverse events in elderly patients undergoing lumbar fusion surgery: comparison of three predictive models. J Orthop Surg Res 2024; 19:8. [PMID: 38166958 PMCID: PMC10763364 DOI: 10.1186/s13018-023-04490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The burden of lumbar degenerative diseases (LDD) has increased substantially with the unprecedented aging population. Identifying elderly patients with high risk of postoperative adverse events (AEs) and establishing individualized perioperative management is critical to mitigate added costs and optimize cost-effectiveness to the healthcare system. We aimed to develop a predictive tool for AEs in elderly patients with transforaminal lumbar interbody fusion (TLIF), utilizing multivariate logistic regression, single classification and regression tree (hereafter, "classification tree"), and random forest machine learning algorithms. METHODS This study was a retrospective review of a prospective Geriatric Lumbar Disease Database (age ≥ 65). Our outcome measure was postoperative AEs, including prolonged hospital stays, postoperative complications, readmission, and reoperation within 90 days. Patients were grouped as either having at least one adverse event (AEs group) or not (No-AEs group). Three models for predicting postoperative AEs were developed using training dataset and internal validation using testing dataset. Finally, online tool was developed to assess its validity in the clinical setting (external validation). RESULTS The development set included 1025 patients (mean [SD] age, 72.8 [5.6] years; 632 [61.7%] female), and the external validation set included 175 patients (73.2 [5.9] years; 97 [55.4%] female). The predictive ability of our three models was comparable, with no significant differences in AUC (0.73 vs. 0.72 vs. 0.70, respectively). The logistic regression model had a higher net benefit for clinical intervention than the other models. A nomogram based on logistic regression was developed, and the C-index of external validation for AEs was 0.69 (95% CI 0.65-0.76). CONCLUSION The predictive ability of our three models was comparable. Logistic regression model had a higher net benefit for clinical intervention than the other models. Our nomogram and online tool ( https://xuanwumodel.shinyapps.io/Model_for_AEs/ ) could inform physicians about elderly patients with a high risk of AEs within the 90 days after TLIF surgery.
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Affiliation(s)
- Shuai-Kang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Zhong-En Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Bridges T, Meade M, Brush P, Lee Y, Narayanan R, McCurdy MA, Lambrechts M, Charlton A, Jenkins E, Juniewicz R, Destine H, Kaye ID, Kurd M, Canseco J, Hilibrand A, Vaccaro AR, Schroeder G, Kepler C. Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery. Global Spine J 2023:21925682231223461. [PMID: 38149647 DOI: 10.1177/21925682231223461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF). METHODS A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes. RESULTS We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until a full diet was provided. This group was found to have a higher rate of postoperative ileus (10.2% vs 2.9%) and urinary retention (16.0% vs 3.9%). The readmission rate and percent of patients presenting to the emergency department within 90 days postoperatively were similar. On multivariate regression analysis, same-day, full-diet patients had decreased odds of developing urinary retention (OR = .17) and a shorter length of hospital stay (Estimate: -.99). Immediate full diet had no impact on the development of ileus (OR: .33). CONCLUSIONS An immediate postoperative full diet following an anterior approach to the lumbar spine was not found to be associated with an increased risk of postoperative ileus in patients deemed appropriate for early diet liberalization. Moreover, an early full diet was found to reduce length of hospitalization and risk of postoperative urinary retention. Reconsideration of postoperative diet protocols may help optimize patient outcomes and recovery.
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Affiliation(s)
- Tiffany Bridges
- Department of Orthopaedic Surgery, Jefferson Health in New Jersey, Stratford, NJ, USA
| | - Matthew Meade
- Department of Orthopaedic Surgery, Jefferson Health in New Jersey, Stratford, NJ, USA
| | - Parker Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael A McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA
| | - Alex Charlton
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Eleanor Jenkins
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Robert Juniewicz
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Henson Destine
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Instituteat Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Heard JC, Lee Y, Lambrechts MJ, Ezeonu T, Dees AN, Wiafe BM, Wright J, Toci GR, Schwenk ES, Canseco JA, Kaye ID, Kurd MF, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Risk Factors for Postoperative Urinary Retention After Lumbar Fusion Surgery: Anesthetics and Surgical Approach. J Am Acad Orthop Surg 2023; 31:1189-1196. [PMID: 37695724 DOI: 10.5435/jaaos-d-23-00172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/20/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Postoperative urinary retention (POUR) after lumbar fusion surgery can lead to longer hospital stays and thus increased risk of developing other postoperative complications. Therefore, we aimed to determine the relationship between POUR and (1) surgical approach and (2) anesthetic agents, including sugammadex and glycopyrrolate. METHODS After institutional review board approval, L4-S1 single-level lumbar fusion surgeries between 2018 and 2021 were identified. A 3:1 propensity match of patients with POUR to those without was conducted, controlling for patient age, sex, diabetes status, body mass index, smoking status, history of benign prostatic hyperplasia, and the number of levels decompressed. POUR was defined as documented straight catheterization yielding >400 mL. We compared patient demographic, surgical, anesthetic, and postoperative characteristics. A bivariant analysis and backward multivariable stepwise logistic regression analysis ( P -value < 0.200) were performed. Significance was set to P < 0.05. RESULTS Of the 899 patients identified, 51 met the criteria for POUR and were matched to 153 patients. No notable differences were observed between groups based on demographic or surgical characteristics. On bivariant analysis, patients who developed POUR were more likely to have been given succinylcholine (13.7% vs. 3.92%, P = 0.020) as an induction agent. The independent predictors of POUR identified by multivariable analysis included the use of succinylcholine {odds ratio (OR), 4.37 (confidence interval [CI], 1.26 to 16.46), P = 0.022} and reduced postoperative activity (OR, 0.99 [CI, 0.993 to 0.999], P = 0.049). Factors protective against POUR included using sugammadex as a reversal agent (OR, 0.38 [CI, 0.17 to 0.82], P = 0.017). The stepwise regression did not identify an anterior surgical approach as a notable predictor of POUR. CONCLUSION We demonstrate that sugammadex for anesthesia reversal was protective against POUR while succinylcholine and reduced postoperative activity were associated with the development of POUR. In addition, we found no difference between the anterior or posterior approach to spinal fusion in the development of POUR.
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Affiliation(s)
- Jeremy C Heard
- From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Heard, Lee, Ezeonu, Dees, Wiafe, Wright, Toci, Canseco, Kaye, Kurd, Hilibrand, Vaccaro, Schroeder, and Kepler), the Department of Orthopaedic Surgery, Washington University, St. Louis, MO (Lambrechts), and the Department Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA (Schwenk)
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Tian D, Liang J, Song JL, Zhang X, Li L, Zhang KY, Wang LY, He LM. Construction and validation of a predictive model for postoperative urinary retention after lumbar interbody fusion surgery. BMC Musculoskelet Disord 2023; 24:813. [PMID: 37833720 PMCID: PMC10571426 DOI: 10.1186/s12891-023-06816-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/19/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Postoperative urine retention (POUR) after lumbar interbody fusion surgery may lead to recatheterization and prolonged hospitalization. In this study, a predictive model was constructed and validated. The objective was to provide a nomogram for estimating the risk of POUR and then reducing the incidence. METHODS A total of 423 cases of lumbar fusion surgery were included; 65 of these cases developed POUR, an incidence of 15.4%. The dataset is divided into a training set and a validation set according to time. 18 candidate variables were selected. The candidate variables were screened through LASSO regression. The stepwise regression and random forest analysis were then conducted to construct the predictive model and draw a nomogram. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and the calibration curve were used to evaluate the predictive effect of the model. RESULTS The best lambda value in LASSO was 0.025082; according to this, five significant variables were screened, including age, smoking history, surgical method, operative time, and visual analog scale (VAS) score of postoperative low back pain. A predictive model containing four variables was constructed by stepwise regression. The variables included age (β = 0.047, OR = 1.048), smoking history (β = 1.950, OR = 7.031), operative time (β = 0.022, OR = 1.022), and postoperative VAS score of low back pain (β = 2.554, OR = 12.858). A nomogram was drawn based on the results. The AUC of the ROC curve of the training set was 0.891, the validation set was 0.854 in the stepwise regression model. The calibration curves of the training set and validation set are in good agreement with the actual curves, showing that the stepwise regression model has good prediction ability. The AUC of the training set was 0.996, and that of the verification set was 0.856 in the random forest model. CONCLUSION This study developed and internally validated a new nomogram and a random forest model for predicting the risk of POUR after lumbar interbody fusion surgery. Both of the nomogram and the random forest model have high accuracy in this study.
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Affiliation(s)
- Dong Tian
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Jun Liang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Jia-Lu Song
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Xia Zhang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Li Li
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Ke-Yan Zhang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China
- Tongji Shanxi Hospital, Taiyuan, China
| | - Li-Yan Wang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China.
- Tongji Shanxi Hospital, Taiyuan, China.
| | - Li-Ming He
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China.
- Third Hospital of Shanxi Medical University, No. 99, Longcheng street, Taiyuan city, 030032, Shanxi Province, China.
- Tongji Shanxi Hospital, Taiyuan, China.
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Jasinski J, Tong D, Yoon E, Claus C, Lytle E, Houseman C, Bono P, Soo TM. Preventing Postoperative Urinary Retention (POUR) in Patients Undergoing Elective Lumbar Surgery: A Quality Improvement Project. Qual Manag Health Care 2023; 32:270-277. [PMID: 36913773 DOI: 10.1097/qmh.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Postoperative urinary retention (POUR) is associated with significant morbidity. Our institution's POUR rate was elevated among patients undergoing elective lumbar spinal surgery. We sought to demonstrate that our quality improvement (QI) intervention would significantly lower our POUR rate and length of stay (LOS). METHODS A resident-led QI intervention was implemented from October 2017 to 2018 on 422 patients in an academically affiliated community teaching hospital. This consisted of standardized intraoperative indwelling catheter utilization, postoperative catheterization protocol, prophylactic tamsulosin, and early ambulation after surgery. Baseline data on 277 patients were collected retrospectively from October 2015 to September 2016. Primary outcomes were POUR and LOS. The focus, analyze, develop, execute, and evaluate (FADE) model was used. Multivariable analyses were used. P value <.05 was considered significant. RESULTS We analyzed 699 patients (277 pre-intervention vs 422 post-intervention). The POUR rate (6.9% vs 2.6%, Δ confidence interval [CI] 1.15-8.08, P = .007) and mean LOS (2.94 ± 1.87 days vs 2.56 ± 2.2 days, Δ CI 0.066-0.68, P = .017) were significantly improved following our intervention. Logistic regression demonstrated that the intervention was independently associated with significantly decreased odds for developing POUR (odds ratio [OR] = 0.38, CI 0.17-0.83, P = .015). Diabetes (OR = 2.25, CI 1.03-4.92, P = .04) and longer surgery duration (OR = 1.006, CI 1.002-1.01, P = .002) were independently associated with increased odds of developing POUR. CONCLUSIONS After implementing our POUR QI project for patients undergoing elective lumbar spine surgery, the institutional POUR rate significantly decreased by 4.3% (62% reduction) and LOS, by 0.37 days. We demonstrated that a standardized POUR care bundle was independently associated with a significant decrease in the odds of developing POUR.
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Affiliation(s)
- Jacob Jasinski
- Division of Neurosurgery, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield
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Koo BS, Park SY, Jang YS, Woo YH, Song S, Yoo JH, Kim MG, Chung JW, Kim SH, Cho HB. Effect of glycopyrrolate on the postoperative urine output of patients following kidney transplantation: a retrospective observational study. J Int Med Res 2023; 51:3000605231202144. [PMID: 37795584 PMCID: PMC10557416 DOI: 10.1177/03000605231202144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVES To compare the urine output and estimated glomerular filtration rate (eGFR) of patients postoperatively administered sugammadex or glycopyrrolate 7 days following kidney transplantation (KT). METHODS We retrospectively enrolled 134 consecutive patients who underwent KT under general anesthesia. Their urine output and eGFR were recorded every 24 hours between postoperative day (POD) 1 and 7. We used regression analysis to evaluate the relationship between the reversal agent administered and the outcomes of the participants. RESULTS The urine output and eGFR of the participants did not differ between the two groups. Multivariate analysis showed that body mass index (BMI) (odds ratio (OR) 1.21; 95% confidence interval (CI) 1.05-1.40), diabetes mellitus (OR 3.14; 95% CI 1.07-9.16), neurovascular disease (OR 7.00; 95% CI 1.61-30.42), and the duration of surgery (OR 1.01; 95% CI 1.00-1.01) were associated with lower urine output on POD 7. In addition, only BMI (OR 1.25; 95% CI 1.09-1.42) was associated with low eGFR on POD 7. CONCLUSIONS The urine output and eGFR of patients administered sugammadex or glycopyrrolate following KT did not differ 7 days later. Moreover, glycopyrrolate does not affect urine output or eGFR on POD 7, according to multivariate regression analysis.
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Affiliation(s)
- Bon Sung Koo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Youn Sil Jang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Young Hoon Woo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Republic of Korea
| | - Sanghoon Song
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Ji Won Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Seoul, Republic of Korea
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Reed LA, Mihas AK, Fortin TA, Donley CJ, Pratheep G, Rajaram Manoharan S, Theiss SM, Viswanathan VK. Risk Factors for Postoperative Urinary Retention Following Lumbar Spine Surgery: A Review of Current Literature and Meta-Analysis. Global Spine J 2023; 13:1658-1670. [PMID: 36562179 PMCID: PMC10448081 DOI: 10.1177/21925682221146493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Systematic Review and Meta-analysis. OBJECTIVE Postoperative urinary retention (POUR) is a common complication following lumbar spine surgery (LSS) and timely recognition is imperative to avoid long-term consequences. The aim of the current meta-analysis was to systematically review the literature in order to identify risk factors associated with POUR after LSS. METHODS In accordance with PRISMA guidelines, a systematic review of the literature was performed using Pubmed, EMBASE, and MEDLINE database for articles on POUR following LSS. A meta-analysis was performed comparing patients with and without POUR; and the factors associated with this adverse event were analyzed. The pooled data were reported as mean differences with 95% confidence intervals (CI; P < .05). Heterogeneity among the studies was evaluated using the I2 statistic. RESULTS The meta-analysis included 10 studies compromised of 30,300 patients. Based on our analysis, patients who were male, were older in age, underwent instrumented fusion, had diabetes mellitus, coronary artery disease, or benign prostatic hypertrophy had significantly higher risk of developing POUR. Additionally, patients in who developed POUR had significantly longer surgical times and higher volumes of intra-operative fluid administration, as compared with non-POUR patients. The POUR patients also had a significantly higher association with urinary tract infection. Prior surgery, BMI, length of stay, and smoking status did not reveal any statistical association with POUR. CONCLUSIONS Risk factors associated with POUR following LSS include male gender, older age, longer surgical times, fusion procedures, larger volumes of intraoperative infusions, and associated comorbidities like DM, CAD, and BPH.
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Affiliation(s)
- Logan A. Reed
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander K. Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Travis A. Fortin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Connor J. Donley
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Guna Pratheep
- Department of Spine Surgery, Ganga Medical Center and Hospitals, Coimbatore, India
| | | | - Steven M. Theiss
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Wang LL, Kang M, Duan LX, Chang XF, Li XX, Guo XY, Kang ZY, Han YZ. Effect of single spinal anesthesia with two doses ropivacaine on urinary retention after hemorrhoidectomy in male patients. Front Surg 2023; 9:1077575. [PMID: 36713672 PMCID: PMC9874284 DOI: 10.3389/fsurg.2022.1077575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
Background Anorectal diseases are common in the population and include internal, external, and mixed hemorrhoids. Although hemorrhoid surgery is a brief operation, anesthesia, anesthetic drugs, drug concentrations, and anesthesia level control are closely related to postoperative uroschesis. For hemorrhoid surgery, a single spinal block with ropivacaine is commonly used that blocks the S2-S4 parasympathetic nervous system, which in turn governs the voiding reflex, causing postoperative urinary retention; this affects the recovery of patients. This study was performed to investigate the effects of two doses ropivacaine that provided satisfactory analgesia and muscle relaxation and inhibited adverse reflexes on urinary retention after hemorrhoidectomy. Methods The study included 200 male patients who underwent anorectal surgery with American Society of Anesthesiologists (ASA) grade I-II single elective spinal anesthesia between March 2021 and March 2022. Patients were randomly assigned to 2 groups using a random number table: Group A (n = 100) received 10 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml), and Group B (n = 100) received 15 mg 0.5% ropivacaine (1.5 ml 1% ropivacaine + 1.5 ml 10% glucose = 3 ml). Results The anal sphincter exhibited good relaxation, and no obvious traction pain or significant difference in the time of muscle strength recovery was observed between the 10 mg and 15 mg 0.5% ropivacaine groups (P > 0.05). The 10 mg 0.5% ropivacaine group had shorter time of micturition exceeding 100 ml and lower voiding International Prostate Symptom Score than the 15 mg 0.5% ropivacaine group (P < 0.01). Conclusions Single spinal anesthesia with 10 mg 0.5% ropivacaine not only provides satisfactory anesthetic effect for hemorrhoidectomy but also has less influence on postoperative uroschesis and is worthy of clinical application. Trial registration The study was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn; identifier: ChiCTR2,100,043,686) on February 27, 2021.
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Affiliation(s)
- Lei-lei Wang
- Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Meng Kang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Li-xin Duan
- Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Xu-fei Chang
- Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Xiao-xin Li
- Department of General Surgery, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Xiang-yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhi-yu Kang
- Department of Anesthesiology, Peking University Third Hospital Yanqing Hospital, Beijing, China,Correspondence: Zhi-yu Kang Yong-zheng Han
| | - Yong-zheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China,Correspondence: Zhi-yu Kang Yong-zheng Han
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Porche K, Maciel CB, Lucke-Wold B, Robicsek SA, Chalouhi N, Brennan M, Busl KM. Preoperative prediction of postoperative urinary retention in lumbar surgery: a comparison of regression to multilayer neural network. J Neurosurg Spine 2022; 36:32-41. [PMID: 34507288 PMCID: PMC9608355 DOI: 10.3171/2021.3.spine21189] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Postoperative urinary retention (POUR) is a common complication after spine surgery and is associated with prolongation of hospital stay, increased hospital cost, increased rate of urinary tract infection, bladder overdistention, and autonomic dysregulation. POUR incidence following spine surgery ranges between 5.6% and 38%; no reliable prediction tool to identify those at higher risk is available, and that constitutes an important gap in the literature. The objective of this study was to develop and validate a preoperative risk model to predict the occurrence of POUR following routine elective spine surgery. METHODS The authors conducted a retrospective chart review of consecutive adults who underwent lumbar spine surgery between June 1, 2017, and June 1, 2019. Patient characteristics, preexisting ICD-10 codes, preoperative pain and opioid use, preoperative alpha-1 blocker use, details of surgical planning, development of POUR, and management strategies were abstracted from electronic medical records. A binomial logistic model and a multilayer perceptron (MLP) were optimized using training and validation sets. The models' performance was then evaluated on model-naïve patients (not a part of either cohort). The models were then stacked to take advantage of each model's strengths and to avoid their weaknesses. Four additional models were developed from previously published models adjusted to include only relevant factors (i.e., factors known preoperatively and applied to the lumbar spine). RESULTS Overall, 891 patients were included in the cohort, with a mean of 59.6 ± 15.5 years of age, 52.7% male, BMI 30.4 ± 6.4, American Society of Anesthesiologists class 2.8 ± 0.6, and a mean of 5.6 ± 5.7 comorbidities. The rate of POUR was found to be 25.9%. The two models were comparable, with an area under the curve (AUC) of 0.737 for the regression model and 0.735 for the neural network. By combining the two models, an AUC of 0.753 was achieved. With a regression model probability cutoff of 0.24 and a neural network cutoff of 0.23, maximal sensitivity and specificity were achieved, with specificity 68.2%, sensitivity 72.9%, negative predictive value 88.2%, and positive predictive value 43.4%. Both models individually outperformed previously published models (AUC 0.516-0.645) when applied to the current data set. CONCLUSIONS This predictive model can be a powerful preoperative tool in predicting patients who will be likely to develop POUR. By using a combination of regression and neural network modeling, good sensitivity, specificity, and NPV are achieved.
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Affiliation(s)
- Ken Porche
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carolina B. Maciel
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
| | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Steven A. Robicsek
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Nohra Chalouhi
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Meghan Brennan
- Department of Anesthesiology, University of Florida, Gainesville, Florida
| | - Katharina M. Busl
- Departments of Neurology and Neurosurgery, University of Florida, Gainesville, Florida
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Risk factors for postoperative urinary retention following elective spine surgery: a meta-analysis. Spine J 2021; 21:1802-1811. [PMID: 34015508 DOI: 10.1016/j.spinee.2021.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/18/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Limited studies have investigated risk factors for postoperative urinary retention (POUR) following elective spine surgery. Furthermore, some discrepancies have been found in the results of existing observational studies. PURPOSE This study aimed to review the available literature on risk factors associated with POUR following elective spine surgery. STUDY DESIGN A systematic review with meta-analysis was performed. PATIENT SAMPLE A total of 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis. OUTCOME MEASURES Demographics, type of elective spine surgery, country, definition of POUR, and potential risk factors for POUR were evaluated. METHODS The Cochrane Library, Embase, and Medline electronic databases were searched to identify relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean differences (WMD) or standardized mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes. RESULTS Eleven studies (2 prospective and 9 retrospective) were included in the analysis. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50-9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04-1.64). The following variables were also identified as significant risk factors for POUR: benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89-7.62), diabetes mellitus (DM; OR, 1.50; 95% CI, 1.17-1.93), and previous urinary tract infection (UTI; OR, 1.70; 95% CI, 1.28-2.24). Moreover, longer operative time (WMD, 19.88; 95% CI, 5.01-34.75) and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23-0.52) were observed in patients with POUR. In contrast, spine surgical procedures involving fewer levels (OR, 0.75; 95% CI, 0.65-0.86), and ambulation on the same day as surgery (OR, 0.65; 95% CI, 0.52-0.81) were associated with a decreased risk of POUR. CONCLUSIONS Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI are risk factors for POUR following elective spine surgery. We also found that longer operative time and increased intravenous fluid support would increase the risk of POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative voiding.
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Key Words
- CAD, coronary artery disease
- CI, confidence Interval
- DM, diabetes mellitus
- Elective surgery
- IAP, intra-abdominal pressure
- IQR, interquartile range
- Meta-analysis Abbreviations: BPH, benign prostatic hyperplasia
- OR, odds ratio
- POUR, postoperative urinary retention
- PVR, post-void residual
- Postoperative urinary retention
- Risk factor
- SD, standard deviation
- SMD, standardized mean differences
- Spine surgery
- Systematic review
- UTI, urinary tract infection
- WMD, weighted mean difference
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