Artikel
What are risk factors for an ileus after spine surgery? A case control study
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Veröffentlicht: | 22. Oktober 2019 |
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Objectives: Bowel dysfunctions like post-operative ileus are often a key factor in determining the hospital length of stay. The etiology of postoperative ileus is multifactorial, including surgical stress, secretion of inflammatory mediators, endogenous opioids in the gastrointestinal tract, changes in hormone levels, as well as imbalances with electrolytes and fluids. The literature is lacking in studies reporting risk factors for bowel dysfunctions after lumbar spine surgeries. The purpose of this retrospective study is to evaluate risk factors for developing a postoperative ileus after posterior lumbar spine surgery.
Methods: Due to the relatively rare occurrence of postoperative ileus, we performed a case control study. Patient charts, including radiographs were evaluated retrospectively. Diagnosis of an ileus was confirmed radiographically by a CT scan in all cases. The control group (ratio 2:1) represented a random sample of patients undergoing posterior spine surgery who did not suffer from a bowel dysfunction postoperatively.
Results and conclusion: A total of 63 patients suffered a gastrointestinal complication after posterior spine surgery. Out of those, 40 patients had a postoperative ileus. The control group consisted of 80 patients without ileus. Both groups did not differ significantly in age, gender, BMI, tobacco use, comorbidities or status of previous abdominal surgery. Significant differences between the two groups was observed in the length of stay (5.9 ± 7.5 vs. 11.2 ± 8.9; p=0.001), lumbar surgery level (47.5% vs. 87.5%; p< 0.001) and major spine surgery > 3 levels (35.0% vs. 57.5%; p=0.019) in the controls and cases, respectively. Patients who suffered from an ileus had a higher risk of ICU treatment (23.8% vs. 37.5%; p=0.115), re-admissions (5.0% vs. 0.0%; p=0.044) and delayed discharge (57.5% vs. 32.5%; p=0.009). Multivariable analysis demonstrated that lumbar spine surgery compared to thoracic and/or cervical spine surgery (p< 0.01; OR 13.2, CI 4.0-43.4) and major spine surgery > 3 levels compared to spine surgeries < 3 levels (p=0.05; OR 3.9, CI 1.5-9.9) are associated with an ileus (Table 1 [Tab. 1]).
Based on our study, we can state that several risk factors, including gender, age, history of previous abdominal surgery and GERD, are somewhat ambiguious in predicting a postoperative ileus. Conversely, lumbar spine surgery and major spine surgery of > 3 levels are associated with a postoperative ileus. While this may make practical sense, our study was one of few in the literature to demonstrate these findings. Further studies are needed to better understand postoperative ileus in spine surgery patients and to further expand on our findings.