Skip to main content

Advertisement

SpringerLink
Log in

The incidence and risk factors for post-operative ileus after spinal fusion surgery: a multivariate analysis

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Post-operative ileus is a recognized complication of surgery. Little is known about the incidence and risk factors for post-operative ileus following spinal fusion surgery. To report the incidence and to assess for independent risk factors of post-operative ileus after spinal fusion surgery.

Methods

Retrospective single-centre cohort study. Patients with prolonged or recurrent post-operative ileus were identified by review of hospital stay documentation. Patients with post-operative ileus were matched 1:2 to a control cohort without post-operative ileus. Uni and multi variate analyses were performed on demographic, comorbidity, surgical indication, medication, and peri-operative details to identify risk factors for post-operative ileus.

Results

Two thousand six hundred and twenty five patients underwent spinal fusion surgery between January 2012 and December 2012. Forty nine patients with post-operative ileus were identified (1.9 %). Post-operative length of hospital stay was significantly longer for patients with post-operative ileus (9.3 ± 5.2 days), than control patients (5.5 ± 3.2 days) (p < 0.001). Independent risk factors were Lactated Ringers solution (aOR: 2.12, p < 0.001), 0.9 % NaCl solution (aOR: 2.82, p < 0.001), and intra-operative hydromorphone (aOR: 2.31, p < 0.01) and a history of gastro-oesophageal reflux (aOR: 4.86, p = 0.03). Albumin administration (aOR: 0.09, p < 0.01) was protective against post-operative ileus.

Conclusions

Post-operative ileus is multifactorial in origin, and this study identified intra-operative hydromorphone and post-operative crystalloid fluid administration ≥2 litres as independent risk factors for the development of ileus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fineberg SJ, Nandyala SV, Kurd MF et al (2014) Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J 14(8):1680–1685

    Article  PubMed  Google Scholar 

  2. Summers RW (2010) Approach to the patient with ileus and obstruction. Textbook of gastroenterology, fourth edn, Vol 1, Chapt 41:829–840

  3. Waldhausen JH, Shaffrey ME, Skenderis BS 2nd et al (1990) Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 211(6):777–784, discussion 785

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Clevers GJ, Smout AJ, van der Schee EJ et al (1991) Myo-electrical and motor activity of the stomach in the first days after abdominal surgery: evaluation by electrogastrography and impedance gastrography. J Gastroenterol Hepatol 6(3):253–259

    Article  CAS  PubMed  Google Scholar 

  5. Prasad M, Matthews JB (1999) Deflating postoperative ileus. Gastroenterology 117:489–492

    Article  CAS  PubMed  Google Scholar 

  6. Al Maaieh MA, Du JY, Aichmair A et al (2014) Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. Spine (Phila Pa 1976) 39(8):688–694

    Article  Google Scholar 

  7. Rajaraman V, Vingan R, Roth P et al (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91(Suppl 1):60–64

    CAS  PubMed  Google Scholar 

  8. Ravinsky RA, Ouellet JA, Brodt ED et al (2013) Vertebral osteotomies in ankylosing spondylitis- comparison of outcomes following clsoing wedge osteotomy: a systematic review. Evid Based Spine Care J 4:18–29

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee TH, Lee JS, Hong SJ et al (2015) Risk factors for postoperative ileus following orthopaedic surgery: the role of chronic constipation. J Neurogastroenterol Motil 21:121–125

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shah KN, Waryasz G, Mason DePasse J et al (2015) Prevention of paralytic ileus utilizing alvimopan following spine surgery. Orthop Rev 7(3):6087–6089

    Article  Google Scholar 

  11. Santos ER, Pinto MR, Lonstein JE et al (2008) Revision lumbar arthrodesis for the treatment of lumbar cage pseudoarthrosis: complications. J Spinal Disord Tech 21(6):418–421

    Article  PubMed  Google Scholar 

  12. Holte K, Kehlet H (2000) Postoperative ileus: a preventable event. Br J Surg 87(11):1480–1493

    Article  CAS  PubMed  Google Scholar 

  13. Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89(4):622–632

    Article  CAS  PubMed  Google Scholar 

  14. Espat NJ, Cheng G, Kelley MC et al (1995) Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 58(6):719–723

    Article  CAS  PubMed  Google Scholar 

  15. Artinyan A, Nunoo-Mensah JW, Balasubramaniam S et al (2008) Prolonged postoperative ileus-definition, risk factors, and predictors after surgery. World J Surg 32(7):1495–1500

    Article  PubMed  Google Scholar 

  16. Condon RE, Cowles V, Ekbom GA et al (1987) Effects of halothane, enflurane, and nitrous oxide on colon motility. Surgery 101(1):81–85

    CAS  PubMed  Google Scholar 

  17. Holte K, Foss NB, Svensen C et al (2004) Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiology 100(2):281–286

    Article  PubMed  Google Scholar 

  18. Livingston EH, Passaro EP Jr (1990) Postoperative ileus. Dig Dis Sci 35(1):121–132

    Article  CAS  PubMed  Google Scholar 

  19. Trescot AM, Glaser SE, Hansen H et al (2008) Effectiveness of opioids in the treatment of chronic non cancer pain. Pain Physician 11:S181–S200

    PubMed  Google Scholar 

  20. Marderstein EL, Delaney CP (2008) Management of postoperative ileus: focus on alvimopan. Ther Clin Risk Manag 4(5):965–973

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Ferraz AA, Cowles VE, Condon RE et al (1995) Opioid and nonopioid analgesic drug effects on colon contractions in monkeys. Dig Dis Sci 40(7):1417–1419

    Article  CAS  PubMed  Google Scholar 

  22. Mecray PM, Barden RP, Ravdin IS (1937) Nutritional edema. Surgery 1:53–64

    Google Scholar 

  23. Borup T, Hahn RG, Holte K et al (2009) Intra-operative colloid administration increases the clearance of a post-operative fluid load. Acta Anaesthesiol Scand 53(3):311–317

    Article  CAS  PubMed  Google Scholar 

  24. Holte K, Kehlet H (2006) Fluid therapy and surgical outcomes in elective surgery: a need for reassessment in fast-track surgery. J Am Coll Surg 202(6):971–989

    Article  PubMed  Google Scholar 

  25. Radhakrishnan RS, Shah SK, Lance SH et al (2009) Hypertonic saline alters hydraulic conductivity and up-regulates mucosal/submucosal aquaporin 4 in resuscitation-induced intestinal edema. Crit Care Med 37(11):2946–2952

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Shah SK, Uray KS, Stewart RH et al (2011) Resuscitation-induced intestinal edema and related dysfunction: state of the science. J Surg Res 166(1):120–130

    Article  PubMed  Google Scholar 

  27. Lobo DN, Bostock KA, Neal KR et al (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection. Lancet 359:1812

    Article  PubMed  Google Scholar 

  28. Krpata DM, Keller DS, Samia H et al (2013) Evaluation of inflammatory markers as predictors of hospital stay and unplanned readmission after colorectal surgery. Pol Przegl Chir 85(4):198–203

    PubMed  Google Scholar 

  29. Kalff JC, Turler A, Schwarz NT et al (2003) Intra-abdominal activation of a local inflammatory response within the human muscularis externa during laparotomy. Ann Surg 237(3):301–315

    PubMed  PubMed Central  Google Scholar 

  30. Tuler A, Abu-Elmagd KM, Kalff JC et al (2002) Molecular inflammatory events within the human intestinal muscularis during small bowel transplantation. Transplant Proc 34(3):921

    Article  CAS  PubMed  Google Scholar 

  31. Schwarz NT, Kalff JC, Turler A et al (2004) Selective jejunal manipulation causes postoperative pan-enteric inflammation and dysmotility. Gastroenterology 126(1):159–169

    Article  CAS  PubMed  Google Scholar 

  32. Lykissas MG, Aichmair A, Farmer J (2013) Sciatic neuritis after lumbar decompression surgery. Spine (Phila Pa 1976) 38(11):E687–E689

    Article  Google Scholar 

  33. Lykissas MG, Aichmair A, Sama AA et al (2014) Nerve injury and recovery after lateral lumbar interbody fusion with and without bone morphogenetic protein-2 augmentation: a cohort-controlled study. Spine J 14(2):217–224

    Article  PubMed  Google Scholar 

  34. Taher F, Hughes AP, Lebl DR et al (2013) Contralateral motor deficits after lateral lumbar interbody fusion. Spine (Phila Pa 1976) 38(22):1959–1963

    Article  Google Scholar 

  35. Aichmair A, Lykissas MG, Girardi FP et al (2013) An institutional six-year trend analysis of the neurological outcome after lateral lumbar interbody fusion: a 6-year trend analysis of a single institution. Spine (Phila Pa 1976) 38(23):E1483–E1490

    Article  Google Scholar 

  36. Lykissas MG, Aichmair A, Hughes AP et al (2014) Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J 14(5):749–758

    Article  PubMed  Google Scholar 

  37. Wiklund P, Ekstrom PA, Edstrom A (2002) Mitogen-activated protein kinase inhibition reveals differences in signalling pathways activated by neurotrophin-3 and other growth-stimulating conditions of adult mouse dorsal root ganglia neurons. J Neurosci Res 67(1):62–68

    Article  CAS  PubMed  Google Scholar 

  38. Lykissas MG, Sakellariou E, Vekris MD et al (2007) Axonal regeneration stimulated by erythropoietin: an experimental study in rats. J Neurosci Methods 164(1):107–115

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nicklaus Childrens Hospital, 3100 SW 62 Avenue, Miami, FL, 33155, USA

    Paul D. Kiely

  2. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lauren E. Mount, Jerry Y. Du, Joseph T. Nguyen, Gil Weitzman, Stavros Memstoudis, Seth A. Waldman & Darren R. Lebl

Authors
  1. Paul D. Kiely
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren E. Mount
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerry Y. Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gil Weitzman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stavros Memstoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seth A. Waldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Darren R. Lebl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paul D. Kiely.

Ethics declarations

Funding

This study did not receive nor was funded by any grant.

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kiely, P.D., Mount, L.E., Du, J.Y. et al. The incidence and risk factors for post-operative ileus after spinal fusion surgery: a multivariate analysis. International Orthopaedics (SICOT) 40, 1067–1074 (2016). https://doi.org/10.1007/s00264-016-3148-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-016-3148-9

Keywords

Search

Navigation