| 【Background】:Postoperative urinary retention(POUR)is a common perioperative complication with an incidence of 5%-70%.Postoperative urinary retention may lead to a second indwelling catheterization,prolong the hospital stay and increase the cost of hospitalization,bring additional pain to the patients,and increase the possibility of other related complications such as urinary tract infection.Therefore,assessing the risk of postoperative urinary retention in spinal surgery patients and taking measures based on the risks can reduce the length of hospital stay and potential complications,reduce the cost of hospitals,patients,and medical insurance,which has important practical significance.【Research content and methods】:Part I,retrospective cohort study: Retrospective analysis was made on the clinical data of 317 patients who underwent posterior lumbar decompression or decompression fusion for lumbar spinal stenosis in the department of orthopedics,Zhongda Hospital affiliated to Southeast University from January 2016 to December 2008,and epidemiological analysis was made on the risk factors of postoperative urinary retention.After screening by inclusion and exclusion criteria,information was extracted from patients’ medical records,including: age,gender,history of BPH,smoking,alcohol consumption,history of diabetes,analgesic use,duration of surgery/anesthesia,intraoperative infusion volume,and postoperative urinary retention;Fisher’s exact probability method and chi-square were used to examine the relationship between each influencing factor and postoperative urinary retention,and multivariate Logistic regression model was established to analyze the independent impact factors influencing incidence of postoperative urinary retention.Part II: systematic review and meta-analysis :A systematic review of published randomized controlled clinical studies was conducted to compare the risk of postoperative urinary retention in patients undergoing lumbar surgery under general anesthesia and regional anesthesia.Applying the established literature retrieval strategy relevant literatures of studies comparing general anesthesia and regional anesthesia line in lumbar spine surgery were retrieve in Pub Med,ISI Web of Science,the Cochrane Library,Wanfang database and CNKI,according to the established inclusion criteria and exclusion criteria,compared postoperative urinary retention of randomized controlled clinical trials,Basic information including author,year of publication,etc.,subtype of the surgery,anesthesia method were extracted from validated literatures.Information such as sample size,improved Jadad scoring scale was used to evaluate the quality of the included literature,and incidence of urinary retention was the basic outcome for comparison.a random effect model was used for calculation of effect size due to small number of studies.Review Manager5.0 was used to summarize and calculate pooled Risk Ratio(RR)of urinary retention after lumbar surgery under the two anesthesia methods.Meanwhile,heterogeneity analysis and publication bias analysis were performed.【RESULTS】: Part I: from January 2016 to December 2012,a total of 317 patients underwent lumbar posterior decompression or lumbar fusion fixation in the department of orthopedics,Zhongda Hospital.94 patients were excluded according to established criteria.Finally,clinical data of 223 patients were included in the retrospective analysis.There were statistically significant differences in age,gender,diabetes mellitus and opioid use between the two groups(P<0.05).Single factor analysis showed that the incidence of postoperative urinary retention increased with age(P<0.05),including 17.9% in young patients(5/28),32.1% in middle-aged patients(25/78),and 41.8% in elderly patients(49/117).Respectively in three groups,according to single factor analysis of postoperative urinary retention time of anesthesia,intraoperative infusion quantity and opioid use POUR risk factors for young patients,intraoperative infusion volume and history of diabetes risk factors for middle-aged patients POUR,male,anesthesia time,intraoperative transfusion amount,BPH history and history for elderly patients with diabetes POUR risk factors;Multivariate Logistic regression analysis showed that in young patients,opioid use and duration of anesthesia were independent risk factors.In middle-aged patients,duration of anesthesia and intraoperative infusion volume were independent risk factors,while in elderly patients,male,diabetes,and BPH history were independent risk factors for POUR.Part II:a total of 12 randomized controlled studies were extracted through literature search and screening and included in the meta-analysis,with a total sample size of 900.Heterogeneity test did not suggest significant heterogeneity among the studies.(χ~2=14.63,P=0.15,I~2=0.32).The results from randomized effect model showed that the RR of regional anesthesia(RA)versus general anesthesia(GA)was 1.18,with a 95% confidence interval [0.77,1.81].In other words,there was no significant difference in the effect of the two anesthesia methods on postoperative POUR.Funnel plots showed no significant publication bias in meta-analysis.【Conclusions】: In this study,the risk factors for post-lumbar POUR included: age,anesthesia/operation time,using opioids,intraoperative infusion volume;For different age groups,there were different independent risk factors.Anaesthesia was not a factor in post-lumbar POUR.This study suggests to POUR due to high risk patients,can be hierarchical targeted nursing,nursing measures including: line of urination training and pelvic floor muscle function in patients with preoperative guidance exercise,reduce the use of intraoperatie infusion and opioids,massage or injection before the drawing tube plug dew in order to promote the excretion of urine,assess the bladder function of limb,early detection of urinary retention and corresponding processing line as soon as possible;So as to improve the quality of life of patients. |
