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Multivariate Analysis on Risk Factors for Postoperative Ileus After Lateral Lumbar Interbody Fusion

Al Maaieh, Motasem A. MD; Du, Jerry Y. BS; Aichmair, Alexander MD; Huang, Russel C. MD; Hughes, Alexander P. MD; Cammisa, Frank P. MD; Girardi, Federico P. MD; Sama, Andrew A. MD

Spine:
doi: 10.1097/BRS.0000000000000238
Surgery
Abstract

Study Design. Retrospective cohort study.

Objective. To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF).

Summary of Background Data. POI is frequently observed in anterior lumbar interbody fusion due to significant bowel manipulation during the approach. LLIF is a minimally invasive approach to the anterior column with reduced bowel manipulation and surgical time. However, there is a paucity of literature on POI after LLIF.

Methods. A retrospective review was performed of records of patients who underwent LLIF from January 2006 to December 2011 at a single institution. Patients with prolonged and recurrent POI were identified by review of hospital stay documentation by a fellowship-trained spine surgeon and a research fellow. POI patients were matched 1:1 to a control cohort without POI. Uni- and multivariate analyses were performed on demographic, comorbidity, surgical indication, medication, and perioperative details to identify independent risk factors for POI.

Results. Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Postoperative length of stay was significantly higher for patients with POI (9.9 ± 4.3 d) than control patients (5.6 ± 4.1 d) (P < 0.001). The incidence of ileus in the first 100 LLIF cases (11%) was not significantly higher than in the last 100 LLIF cases (6%) (P = 0.21). Independent risk factors were history of gastroesophageal reflux disease (P < 0.01, adjusted odds ratio [aOR]: 24.31), posterior instrumentation (P = 0.002, aOR: 19.48), and LLIF at L1–L2 (P = 0.04, aOR: 7.82). A history of prior abdominal surgery approached significance as an independent protective factor (P = 0.07, aOR: 0.29).

Conclusion. There was a relatively high incidence of POI after LLIF. Independent risk factors for POI were a history of gastroesophageal reflux disease, posterior instrumentation, and LLIF at L1–L2. A history of prior abdominal surgery approached significance as an independent protective factor.

Level of Evidence: 3

In Brief

A retrospective cohort study identified history of gastroesophageal reflux disease, posterior instrumentation, and surgery at L1&amp;#x2013;L2 as independent risk factors for postoperative ileus after lateral lumbar interbody fusion.

Author Information

From the Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.

Address correspondence and reprint requests to Jerry Y. Du, BS, Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery/Weill Cornell Medical College, 535 East 70th St. New York, NY 10021; E-mail: duj@hss.edu

Acknowledgment date: November 25, 2013. Revision date: January 7, 2014. Acceptance date: January 9, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties, payment for development of educational presentations, stocks.

© 2014 by Lippincott Williams & Wilkins