Prevention of Paralytic Ileus Utilizing Alvimopan Following Spine Surgery

Paralytic ileus in the United States: A cross-sectional study from the national inpatient sample

Introduction:

Paralytic ileus is a common clinical condition leading to significant morbidity and mortality. Most studies to date have focused on postoperative ileus, a common but not exclusive cause of the condition. There are limited epidemiological data regarding the incidence and impact of paralytic ileus and its relationship to other clinical conditions. In this cross-sectional study, we analyzed national inpatient hospitalization trends, demographic variation, cost of care, length of stay, and mortality for paralytic ileus hospitalizations as a whole.

Methods:

The National Inpatient Sample database was used to identify all hospitalizations with the diagnosis of paralytic ileus (International Classification of Diseases, 9th Revision code 560.1) as primary or secondary diagnosis during the period from 2001 to 2011. Statistical analysis was performed using Cochran–Armitage trend test, Wilcoxon rank sum test, and Poisson regression.

Results:

In 2001, there were 362,561 hospitalizations with the diagnosis of paralytic ileus as compared to 470,110 in 2011 (p < 0.0001). The age group 65–79 years was most commonly affected by paralytic ileus throughout the study period. In-hospital all-cause mortality decreased from 6.03% in 2001 to 5.10% in 2011 (p < 0.0001). However, the average cost of care per hospitalization increased from US$19,739 in 2001 to US$26,198 in 2011 (adjusted for inflation, p < 0.0001).

Conclusion:

There was a significant rise in the number of hospitalizations of paralytic ileus with increased cost of care and reduced all-cause mortality.

The risk factors for postoperative ileus following posterior thoraco-lumbar spinal fusion surgery

OBJECTIVE

Postoperative ileus (PI) is a common complication following posterior thoraco-lumbar spinal fusion surgery. It usually slows patient's recovery and increases postoperative morbidity. However, the risk factors associated with PI in patients undergoing posterior thoraco-lumbar spinal fusion surgery are still unclear. The purpose of this study is to investigate the potential risk factors for PI in those patients.

PATIENTS AND METHODS

A prospective study was conducted and 426 patients received posterior thoraco-lumbar spinal fusion surgery between March 2017 and February 2018 were included in this study. The associations between different clinical factors and PI were analyzed. A logistic regression analysis was performed to detect independent risk factors for PI. The cut-off value, sensitivity and specificity of these independent factors were calculated by receiver operating characteristic (ROC) curve.

RESULTS

In this study, 8.2% (35/426) of these patients were identified with PI. The average length of postoperative hospital stay was 12.54 ± 6.06 days in patients with PI compared with 8.91 ± 3.81 days in patients without PI (P =  0.001). These results indicated that surgical duration, PLIF approach, blood loss and length of postoperative diet restriction were potential risk factors for PI in patients with thoraco-lumbar spinal fusion surgery. The cut-off values of surgical duration, blood loss and length of postoperative diet restriction were 4.375 h, 750 ml and 9.5 h, respectively. Combination of surgical duration, PLIF approach, blood loss and length of postoperative diet restriction has the highest predictive value for PI (AUC = 0.910, P <  0.001).

CONCLUSION

Based on the study, surgical duration, PLIF approach, blood loss and length of postoperative diet restriction were the independent risk factors for PI in patients with posterior thoraco-lumbar spinal fusion surgery. Combined those factors has the highest risk for developing PI.

Acute Appendicitis After Spine Fusion for Adolescent Idiopathic Scoliosis: A Case Report

Appendicitis is a common cause of pediatric abdominal pain, largely occurring in the second decade of life. We present the case of a 14-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis, who later developed abdominal pain, nausea, and emesis secondary to acute appendicitis. Her hospital course was significant for prolonged intravenous use of narcotics for pain control and subsequent constipation but negative for abdominal pain or tenderness during her admission. While gastrointestinal complications are a common cause of unplanned 30-day readmissions in the pediatric population, appendicitis has yet to be reported. To our knowledge, this is the first case report of acute appendicitis after posterior spinal fusion, likely resulting from postoperative pain management.

A Prospective Single-blind Randomized Controlled Trial of Chewing Gum on Bowel Function Recovery After Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis

PURPOSE

To evaluate the effectiveness of chewing gum on promoting bowel function recovery in adolescent idiopathic scoliosis patients undergoing surgical correction.

MATERIALS AND METHODS

Adolescent idiopathic scoliosis patients scheduled for posterior spinal fusion surgery at our institution were randomized to either group 1 (chewing gum) or group 2 (control). The primary endpoints were time to flatus, time to bowel movement, length of hospital stay, and time to liquid or solid. The secondary endpoints were postoperative opioid consumption, incidence of complications, pain scores, and nausea scores. In addition, a meta-analysis of available data from the literature was performed identifying 2 studies with quantitative data on the efficacy of gum chewing after scoliosis correction surgery.

RESULTS

In total, 125 patients (63 gum; 62 control) were included in our analysis after randomization. There was no significant difference in time to first flatus (P=0.087), time to bowel movement (P=0.307), time to liquid or solid, length of postoperative hospital stay (P=0.954), postoperative complications, opioid consumption, and postoperative nausea scores between the 2 groups. The postoperative pain scores on postoperative day 1 were significantly lower (P=0.027). There was a significant decrease in the time to the first flatus for patients having selective thoracic fusion in both groups than those having fusion to lumbar spine. Meta-analysis also indicated there was no significant difference in outcomes of bowel function between the 2 groups.

CONCLUSIONS

Our institutional data and meta-analysis collaboratively suggested that chewing gum did not hasten the return of bowel function.

Risk Factors for Postoperative Ileus after Scoliosis Surgery

INTRODUCTION

One complication after scoliosis surgery is ileus; however, few reports have described the frequency of and risk factors for this complication. We conducted a retrospective clinical study with logistic regression analysis to confirm the frequency of and risk factors for ileus after scoliosis surgery.

METHODS

After a retrospective review of data from patients who underwent surgical correction of spinal deformity from 2009 to 2014, 110 cases (age range, 4-73 yr; median, 14 yr) were included in the study. We defined postoperative ileus (POI) as a surgical complication characterized by decreased intestinal peristalsis and the absence of stool for more than 3 days postoperatively. Various parameters were compared between patients with POI and those without POI. Logistic regression analysis was performed to assess the risk factors associated with ileus; a P value of <0.05 was considered statistically significant.

RESULTS

Fifteen of 110 (13.6%) cases developed POI. The median height, weight, operation time, and blood loss volume of the patients with versus without POI were 146 versus 152 cm, 39.0 versus 44.0 kg, 387 versus 359 min, and 1590 versus 1170 g, respectively. There were no significant differences between patients with versus without POI in the measured parameters, with the exception of patient height, bed rest period, and presence of neuromuscular scoliosis. Multiple logistic regression analysis revealed neuromuscular scoliosis as a significant risk factor for POI (odds ratio, 4.21; 95% CI, 1.23-14.40).

CONCLUSIONS

Our findings indicate a high probability of POI after scoliosis surgery, with an incidence of 13.6%. Neurogenic scoliosis, but not lowest instrumented vertebra or correction rate, was a risk factor for POI after scoliosis surgery. Digestive symptoms should be carefully monitored after surgery, particularly in patients with neuromuscular scoliosis.