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Prediction model for postoperative urinary retention in patients undergoing totally extraperitoneal groin hernia
Chulhyo Jeon1, Sanguk Hwang2, Jinbeom Cho3
1Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Background:
Postoperative urinary retention remains a common complication after totally extraperitoneal groin hernia repair, often prolonging hospitalization and increasing patient discomfort. This study aimed to develop a prediction model using machine learning for postoperative urinary retention risk stratification.
Methods:
A retrospective analysis was conducted on 1,125 patients who underwent elective totally extraperitoneal between April 2017 and September 2024. Postoperative urinary retention was defined as postoperative residual urine volume ≥400 mL confirmed by catheterization. Logistic regression was used as a preliminary screening to identify candidate predictors. Subsequently, a Gradient Boosting analysis was applied to these candidate predictors, and based on Gradient Boosting-derived feature importance, a simplified scoring system was established.
Results:
Postoperative urinary retention occurred in 58 (5.16%) patients. Gradient Boosting analysis, on the basis of variables initially screened by logistic regression, identified advanced age, lower body mass index, longer operative time, and increased intraoperative fluid volume as the 4 most important predictors, collectively accounting for 89% of the predictive contribution. On the basis of these predictors, a simplified scoring system was developed, demonstrating good discrimination (area under the receiver-operating characteristic curve = 0.7803, 95% confidence interval, 0.667-0.797), satisfactory calibration (Brier score = 0.0465, 95% confidence interval, 0.036-0.057), and event-balanced performance that exceeded baseline prevalence (area under the precision-recall curve = 0.160, 95% confidence interval, 0.099-0.251).
Conclusion:
A 3-tier clinical recommendation was established: low-risk (0-3 points, discharge without monitoring), intermediate-risk (4-6 points, outpatient monitoring), and high-risk (≥7 points, inpatient observation); decision-curve analysis demonstrated a positive net benefit for this scheme across threshold probabilities between 4% and 15%, supporting its use for selective postoperative management after totally extraperitoneal repair. Prospective external validation is warranted.
