348 - Incidence and Risk Factors of Postoperative Ileus Following Lumbar Fus...

#348 Incidence and Risk Factors of Postoperative Ileus Following Lumbar Fusion

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: A postoperative ileus is a potential complication following a lumbar fusion (LF). In order characterize the incidence of a postoperative ileus a population-based database was analyzed with regards to the patient characteristics, hospital resource utilization, outcomes, and mortality.

Methods: The Nationwide Inpatient Sample (NIS) was queried from 2002-2011. Patients diagnosed with a postoperative ileus after undergoing an anterior lumbar fusion (ALF), posterior lumbar fusion (PLF), or a simultaneous anterior-posterior lumbar fusion (APLF) for degenerative diagnoses were identified. Patient demographics, Charlson Comorbidity Index (CCI), length of stay (LOS), costs, and mortality were assessed. SPSS v.20 was utilized for statistical analysis with Student´s T-test for discrete variables and χ2-test for categorical data. Multinomial logistic regression identified independent predictors of postoperative ileus. A p-value of < 0.001 denoted significance.

Results: A total of 263,192 LF were identified between 2002-2011 of which 25,505 (9.7%) were ALFs, 213,457 (81.1%) were PLFs, and 24,230 (9.2%) were APLFs. The incidence of a postoperative ileus was significantly greater in the ALF and APLF cohorts, when compared to the PLF cohort (71.4 and 79.5 vs 23.9 per 1,000 cases respectively, p< 0.001). In both the PLF and APLF cohorts, patients with ileus were significantly older and demonstrated a greater comorbidity burden (p< 0.001). Regardless of the surgical technique, patients with a postoperative ileus incurred a significantly greater LOS and total hospital costs. A postoperative ileus was associated with a greater mortality rate in the PLF-treated patients (4.7 vs 0.9 per 1,000 cases, p< 0.001). Regression analysis demonstrated that male gender, 3+ fusion levels, utilization of bone morphogenetic protein (BMP), alcohol abuse, anemia, fluid/electrolyte disorders, pulmonary circulation disorders, and recent weight loss were independent predictors of a postoperative ileus (p< 0.001).

Conclusions: An anterior or a circumferential lumbar fusion are associated with a greater incidence of a postoperative ileus when compared to a posterior approach. Patients with a postoperative ileus incurred a greater LOS and total hospital costs. In addition, PLF-treated patients with ileus demonstrated a greater mortality rate. In light of these findings, further research is warranted to characterize the risk factors associated with a postoperative ileus in order to mitigate the impact of this complication on hospital resource utilization and adverse patient outcomes.

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