Sex-Specific Differences and Risk Factors for Postoperative Urinary Retention after Spine Surgery with TIVA

To identify sex-specific risk factors for postoperative urinary retention (POUR) in patients undergoing spine surgery with total intravenous anesthesia (TIVA) and explore differences between male and female patients.

A retrospective chart review was conducted on 446 adult patients (268 males, 178 females) who underwent spine surgery with TIVA from January 1, 2019 to December 31, 2023. Propensity score matching was applied to adjust for confounding variables, resulting in 328 matched patients (164 males and 164 females). Multivariable logistic regression analyses were performed to identify independent risk factors for POUR. Residual urine volume ≥300 mL was used to define POUR.

Male patients had a higher incidence of POUR compared to female patients. Significant risk factors for POUR in males included myelopathy (adjusted odds ratio [aOR], 5.17; 95% confidence interval [CI], 1.11-24.15), benign prostatic hyperplasia (BPH) (aOR, 2.63; 95% CI, 1.02-6.78), and prolonged anesthesia time ≥240 minutes (aOR, 2.54; 95% CI, 1.13-5.72). No significant risk factors were found in female patients. Myelopathy and prolonged anesthesia were associated with an increased risk of POUR across the overall population.

Male sex, myelopathy, BPH, and prolonged anesthesia time are significant risk factors for POUR following spine surgery with TIVA. Given these findings, particular attention should be paid to myelopathy, a history of BPH, and anesthesia time in male patients.