Risk factors for postoperative ileus after oblique lateral interbody fusion: a multivariate analysis |
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| Authors: | Sung Cheol Park Sam Yeol Chang Sujung Mok Hyoungmin Kim Bong-Soon Chang Choon-Ki Lee |
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| Institution: | 1. Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, South Korea;2. Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, South Korea;3. Department of Plastic and Reconstructive Surgery, College of Medicine, Yeongnam University, Daegu, South Korea;1. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-8510, Japan;2. Spine Care Center, Wakayama Medical University Kihoku Hospital, 219 Myoji, Katsuragi-cho, Wakayama 649-7113, Japan;3. Department of Orthopaedic Surgery, Hidaka Hospital, 116-2 Sono, Gobo-city, Wakayama 644-0002, Japan;4. Department of Orthopaedic Surgery, Brigham and Women''s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;1. Second Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, 415 Fengyang Rd, Shanghai, China, 200001;2. Department of Spine Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, China, 200433;3. Department of Spine Surgery, Shanghai First People''s Hospital, Shanghai Jiao Tong University, 85 Wujin Rd, Shanghai, China, 200080;4. Department of Orthopedics, Linzhou Hospital of Traditional Chinese Medicine, 244 Taihang Rd, Linzhou, China, 456550;5. Department of Orthopedics, Fifth Hospital of Southern Medical University, Southern Medical University, 566 Congcheng Ave, Guangzhou, China, 510900;6. Department of Spine Surgery, Shenzhen Hospital of Beijing University, 1120 Lianhua Rd, Shenzhen, China, 518036;7. Department of Spine Surgery, General Hospital of Nanjing Military Command, 305 East Zhongshan Rd, Nanjing, China, 210000;1. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands;2. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada;3. Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;5. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA;6. Division of Surgery, McGill University and Montreal General Hospital, Montreal, Quebec, Canada;7. National Center for Spinal Disorders and Buda Health Center, Budapest, Hungary;8. GSpine4 Spine Surgery Division, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;9. Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada;10. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA;11. Department of Neurosurgery, The University of Kansas Hospital, Kansas City, KS, USA;12. Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA;13. Division of Spine, Department of Orthopedics, University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada;14. Research Department, AOSpine International, Davos, Switzerland |
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| Abstract: | Background ContextOblique lateral interbody fusion (OLIF)–has become a widely used, efficient surgical tool for various degenerative lumbar conditions. Postoperative ileus (POI) is a relatively common complication after anterior lumbar interbody fusion due to the manipulation of the intestine during the surgical approach. However, to our knowledge, little is known about POI following OLIF even though it also involves bowel manipulation during a surgical procedure.PurposeTo assess the incidence of POI and identify independent risk factors for POI development after OLIF.Study Design/SettingRetrospective cohort study.Patient SampleAll consecutive patients who underwent OLIF and percutaneous pedicle screw instrumentation from August 2012 until October 2019 at a single institutionOutcome MeasuresPatient demographics (sex, age, body weight, height, and body mass index), comorbidities (diabetes mellitus, gastroesophageal reflux disease, antithrombotic medication, previous abdominal surgery, and previous lumbar surgery), and perioperative details (preoperative diagnosis, number of levels fused, inadvertent endplate fracture during cage insertion, type of interbody graft, intraoperative estimated blood loss, duration of surgery and anesthesia, the amount of intraoperative remifentanil and propofol used as anesthetic agents, the total postoperative retroperitoneal closed-suction drainage output, and the cumulative opioid dosage administered in the first 72 hours postoperatively).MethodsPOI was defined as 2 or more of the following at 72 hours postoperatively: (1) ongoing nausea or vomiting postoperatively, (2) the absence of flatus over last 24-hour period, (3) inability to tolerate an oral diet over last 24-hour period, (4) ongoing abdominal distention postoperatively, and (5) radiological confirmation. The subjects were divided into 2 groups: patients with POI and those without POI. Binary logistic regression analyses were performed on demographics, comorbidities, and perioperative factors to identify independent risk factors for POI.ResultsEighteen (3.9%) of 460 patients experienced POI after OLIF and percutaneous pedicle screw instrumentation. Patients with POI had a significantly longer postoperative length of hospital stay than those without POI (8.61 ± 2.66 vs 6.48 ± 2.64, p = .001). Multivariate logistic regression analysis identified inadvertent endplate fracture (adjusted odds ratio = 6.017, p = .001) and the amount of intraoperative remifentanil (adjusted odds ratio = 1.057, p = .024) as independent risk factors for the occurrence of POI following OLIF.ConclusionThis study identified inadvertent endplate fracture and the amount of intraoperative remifentanil as independent risk factors for the development of POI after OLIF. |
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