Preoperative Hypoalbuminemia, Functional Dependence, and Intraoperative Infusion Volume Associated with Postoperative Urinary Retention After Elective Spinal Surgery

Purpose: To investigate the prevalence and preoperative and intraoperative risk factors associated with postoperative urinary retention (POUR) in patients undergoing elective spinal surgery. Methods: A cross-sectional, descriptive-analytical study was conducted at a tertiary hospital in China between October and November 2025. A total of 177 adult patients undergoing elective cervical, lumbar, or scoliosis surgery with planned postoperative catheter removal were included. Data collected included demographic and clinical characteristics. Univariate and multiple logistic regression analyses were performed to examine associations between preoperative factors and POUR. Results: POUR occurred in 14.7% of patients. Multiple analysis identified three independent risk factors for POUR: intraoperative infusion volume exceeding 2000 mL (OR = 6.714, 95% CI: 1.980– 22.764, P = 0.002), lower preoperative Barthel Index scores (OR = 0.379, 95% CI: 0.243– 0.590, P < 0.001), and lower preoperative serum albumin levels (OR = 0.086, 95% CI: 0.008– 0.881, P = 0.039). Conclusion: Higher intraoperative fluid administration, lower functional status, and preoperative hypoalbuminemia are significant risk factors for POUR following spinal surgery. These findings provide a basis for future research aimed at developing predictive tools and targeted perioperative strategies to identify and manage patients at risk for POUR. Keywords: postoperative urinary retention, spinal surgery, intraoperative fluid management, hypoalbuminemia, barthel index, risk factors