Cost of Postoperative Urinary Retention After Elective Spine Surgery: Significant Variation by Surgeon and Department. (16th November 2020)

• Record Type: Journal Article
• Authors: Mouchtouris, Nikolaos; Hines, Kevin; Fitchett, Evan M; Andrews, Carrie E; Das, Somnath; Patel, Kamini; Vaccaro, Alexander R; Sharan, Ashwini D; Harrop, James S
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_115
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Post-operative urinary retention (PUR) is a common complication after spine surgery with a reported incidence ranging from 5.6% to 38%. Though frequently a benign and self-limited postoperative process, PUR in the setting of lumbar spine surgery can be the initial sign of significant neurologic injury due to compressive hematoma or direct insult. This often leads to an excessive and costly workup. Despite the high prevalence of PUR and the diagnostic challenge it poses, there is a paucity of guidelines for diagnosis and management of PUR. METHODS: Between 10/2015 through 3/2018, 4, 770 patients underwent elective spine surgery through either the Department of Neurological (6 surgeons) or Orthopedic Surgery (7 surgeons) at our institution. Patients with a diagnosis of PUR during their admission were identified using the ICD-10 codes: R33.9 (retention of urine, unspecified), R33.8 (other retention of urine), and R33.0 (drug induced retention of urine). RESULTS: We studied 2, 024 patients on the neurosurgical service and 2, 746 patients on the orthopedic service. Rates of PUR were significantly higher in neurosurgical (7.26%) compared to orthopedic (4.22%) patients (OR 1.776, P < .001). The neurosurgical patients had a significantly higher cost per hospital day ($7, 057 ± 3, 987) compared to orthopedic patients ($6, 125 ± 3, 074; P = .039). Rates of PUR were found to vary between attending surgeons from 2.9% to 11.5% ( P = .348). The PUR incidence varied significantly from 2.9% to 11.5% for Neurosurgery ( P = .049), whereas the PUR rate was 3.1% to 5.5% in Orthopedics ( P = .949). The cost per hospital day ranged from $9, 297 to $10, 145 for the neurosurgeons, versus $8, 964 to $9, 560 for orthopedic surgeons. CONCLUSION: This variation in the diagnostic criteria and management leads to significant variation in cost between surgeons, departments, and practices. There is thus a pressing need for consensus guidelines for this common problem.