Defining optimal postvoid residual volume thresholds for predicting delayed postoperative urinary retention in spinal surgery.

Background Context: Postoperative urinary retention (POUR) is a common complication following spinal surgery, increasing patient morbidity through prolonged hospital stays and urinary infections. Traditional diagnostic criteria, relying on two consecutives postvoid residual (PVR) volumes of 300 mL, may fail to predict delayed POUR in cases with initial PVR below this threshold.

Purpose: This study aims to establish refined PVR cut-off values that can predict delayed POUR in spinal surgery patients, incorporating stratified thresholds based on identified risk factors such as gender and age. By defining these specific thresholds, the study seeks to enhance postoperative voiding care protocols and improve clinical decision-making regarding the need for continued urinary monitoring.

Study Design: Retrospective, single-center cohort study.

Patient Sample: This study included 310 patients aged 18 years or older who underwent elective thoracolumbar spinal surgery with intraoperative Foley catheterization between January 2021 and December 2023.

Outcome Measures: The primary outcome was the occurrence of delayed POUR, defined as PVR exceeding 300 mL after postoperative voiding care protocols concluded.

Methods: All patients underwent bladder scan after Foley catheter removal to measure PVR volumes. Multivariable logistic regression analyses were used to identify risk factors of POUR. Receiver operating characteristic (ROC) curve analysis was conducted to determine optimal PVR thresholds for delayed POUR stratified by gender, age, surgical levels, and ADS score.

Results: Delayed POUR occurred in 38 patients (11.9%) and was significantly associated with older age (≥75 years: OR 3.02, 95% CI 1.32-6.94, p=.009), higher initial PVR per 100 mL (OR 2.96, 95% CI 1.77-4.96, p<.001), and Anticholinergic drug score (ADS) ≥ 2 (OR 2.57, 95% CI 1.06-6.28, p=.038). ROC analysis identified optimal PVR thresholds for predicting delayed POUR: 61 mL for male patients (AUC=0.68) and 101 mL for female patients (AUC=0.77). Further subgroup analysis revealed lower cut-off values for patients at higher risk, such as those with multiple surgical levels or ACS ≥ 2.

Conclusions: This study establishes refined PVR cut-off values for predicting delayed POUR in spinal surgery patients, offering a stratified approach based on patient-specific factors. These findings support a shift toward personalized postoperative voiding care protocols, improving early detection and intervention to prevent complications associated with urinary retention.