Summary: This is a single surgeon randomized prospective series of patients with AIS to determine whether a preoperative bowel prep reduces postoperative bowel morbidity and length of stay.
Introduction: Constipation is common following scoliosis surgery due to the need for narcotics, dietary changes, and immobilization. Crawford(2005) reported 78 percent of patients undergoing spinal surgery developed GI morbidity postoperatively, resulting in prolonged hospital stays. The purpose of this study is to determine if a pre‐op bowel preparation decreased the incidence of post‐op GI morbidity and length of hospital stay for children undergoing surgery for AIS. We hypothesized that patients having a pre‐operative bowel prep would have reduced bowel morbidity and a shorter length of stay following scoliosis surgery.
Methods: We conducted an IRB‐approved, randomized, prospective study of 60 patients who underwent PSIF for AIS at our institution between June 2007 and July 2009. After informed consent, patients were randomized into two groups: Group A received a pre‐op bowel prep using NuLytley®, and Group B received no pre‐op bowel prep. Post‐op data collection included time of last bowel movement pre‐operatively, abdominal girth, bowel sounds, nausea, emesis, ambulation, weight, pain management (Epidural/PCA), medication (pain), medication (constipation), abdominal pain, date transitioned to oral medication, oral intake and stool output, and length of stay. All patients followed a standardized post‐operative bowel protocol and dietary regimen.
Results: 60 patients were consecutively enrolled and randomized into the two groups. The groups were evenly matched for age and gender. In Group A, 5 patients did not tolerate the bowel prep, leaving 25 patients in Group A and 30 in Group B. Group A had significantly less weight gain (p<0.09), fewer post‐op bowel medications (p<0.023) and a shorter time to 1st bowel movement (p<0.03) than the controls. However, there was no difference in length of stay between the two groups (p=0.222).
Conclusion: These data show a modest reduction in some aspects of bowel morbidity by pre‐op bowel prep before scoliosis surgery. There is no evidence that a pre‐operative bowel prep reduces length of stay or other parameters of bowel morbidity.
Significance: Post‐operative bowel morbidity remains a relevant problem after scoliosis surgery. Pre‐op bowel prep does not significantly reduce post‐op bowel morbidity or length of stay.