Role of α1-antagonists in postoperative urinary retention following lumbar spine surgery: a propensity score-matched analysis.

OBJECTIVE: Postoperative urinary retention (POUR) commonly occurs following elective lumbar spine surgery. POUR can result in prolonged admission, urinary tract infection (UTI), and patient morbidity. Prophylactic α1-antagonist therapy is often used to reduce the risk of this complication. The aim of this study was to identify the incidence of POUR in this population and determine the effect of prophylactic α1-antagonists using a propensity score (PS)-matched model. METHODS: This retrospective review included patients who underwent elective lumbar spine surgery at a single institution between 2015 and 2021. PSs were generated for the likelihood of receiving prophylactic α1-antagonists immediately after surgery. PS matching was performed using 1:1 nearest-neighbor matching (0.01 caliper) without replacement. From this matched cohort, a random-effects model accounting for variation in surgeon practice was used to assess factors associated with POUR. RESULTS: Overall, 2326 patients were identified and 506 were successfully PS matched. The overall incidence of POUR was 8.8%. Immediately postoperatively, 422 patients (18.1%) received prophylactic α1-antagonist therapy (treatment group) and 1904 patients did not (controls). Prior to matching, there were significant differences between the control and treatment groups. In the multivariable random-effects model of the 506 matched patients, POUR was associated with the use of prophylactic α1-antagonists after surgery (RR 1.94, 95% CI 1.07-3.52), female sex (RR 1.83, 95% CI 1.41-2.39), intraoperative Foley catheter use (RR 0.25, 95% CI 0.12-0.52), the normalized duration of surgery (RR 0.42, 95% CI 0.20-0.88), patient-controlled anesthesia use (RR 2.63, 95% CI 1.47-4.70), and postoperative UTI (RR 3.52, 95% CI 1.34-9.21). CONCLUSIONS: Prophylactic α1-antagonist use immediately after surgery did not reduce POUR, and patients who received prophylaxis were at greater risk of POUR in this large PS-matched analysis. Female sex was associated with a greater incidence of POUR while intraoperative Foley catheter use and a longer operative duration were associated with reduced risk of POUR. Potentially modifiable risk factors, such as patient-controlled anesthesia use and UTI, significantly increased the risk of POUR and thus should be addressed in the early postoperative setting.