Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion

Fineberg, Steven J.; Nandyala, Sreeharsha V.; Kurd, Mark F.; Marquez-Lara, Alejandro; Noureldin, Mohamed; Patel, Alpesh A.; Oglesby, Matthew; Singh, Kern

doi:10.1016/j.spinee.2013.10.015

Cited by 93 publications

(70 citation statements)

References 24 publications

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“…Patients undergoing lumber spinal surgery usually encounter postoperative transient gastrointestinal (GI) dysfunction due to prolonged bed rest. The incidence of postoperative ileus was 26.0 per 1,000 (Fineberg et al, 2014) in posterior lumbar fusions and postoperative ileus was associated with increased length of hospital and costs. Potential mechanisms/factors leading to GI dysfunction may include activation of inhibitory sympathetic reflexes, systematic use of opioids, surgical trauma-induced inflammatory responses, and prolonged bed rest (Bauer and Boeckxstaens, 2004).…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Dexmedetomidine Accelerates Gastrointestinal Function Recovery in Patients Undergoing Lumbar Spinal Fusion

Wang

Xiao

et al. 2019

Front. Pharmacol.

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Background: Dexmedetomidine possesses sedative, sympatholytic, and opioid-sparing properties, but its impact on postoperative gastrointestinal function is controversial.Methods: This single-center, prospective, randomized study compared low-dose dexmedetomidine and placebo on gastrointestinal function recovery and inflammation after posterior lumbar spinal fusion. Sixty-six patients were randomized into two groups and received normal saline (control group) or dexmedetomidine (DEX group) during posterior lumbar fusion. Blood was taken at five timepoints to measure lipopolysaccharides, tumor necrosis factor-a, and C-reactive protein. The primary outcome was duration to first flatus. The secondary outcomes were inflammatory mediators and determination of correlations between perioperative factors and duration to first flatus.Results: Patients in DEX group showed significantly lower duration to first flatus (15.37 [13.35-17.38] vs 19.58 [17.31-21.86] h; p = 0.006) and overall sufentanil consumption (67.19 [63.78-70.62] vs 74.67 [69.96-79.30] mg; p = 0.011) than controls. Lipopolysaccharides, tumor necrosis factor-a, and C-reactive protein did not differ between the groups at any timepoint (all p > 0.05). Multiple linear regression modeling assessed the ability of independent variables to predict variance in duration to first flatus (adjusted R 2 = 0.379, p = 0.000). In the model, age (b = 0.243, p = 0.003), gender (b = −3.718, p = 0.011), BMI (b = −0.913, p = 0.001), operative segments (b = −4.079, p = 0.028), and overall sufentanil consumption (b = 0.426, p = 0.000) contributed significantly.Conclusions: Thus, low-dose dexmedetomidine accelerates gastrointestinal function recovery after lumbar spinal fusion. The effect may be partially produced by opioid-sparing effects rather than inhibition of inflammation.Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR1800018127.

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Section: Introductionmentioning

confidence: 99%

Low-Dose Dexmedetomidine Accelerates Gastrointestinal Function Recovery in Patients Undergoing Lumbar Spinal Fusion

Wang

Xiao

et al. 2019

Front. Pharmacol.

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“…Anemia was more common among readmitted patients. 21 This is not surprising since anemia has been shown to be a preoperative risk factor in the neurosurgery of the spine, associated with ileus in lumbar fusion, 11 posterior lumbar spine surgery, 14 and postoperative delirium after lumbar surgery. 12 Intraoperative acute blood loss anemia also has been reported to relate to perioperative cardiac events following cervical and lumbar spine surgery.…”

mentioning

confidence: 99%

Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality improvement are discussed.

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“…Many published studies from the spine surgery literature have used ICD-9 -coded databases, such as the NIS, to examine relationships between preoperative anemia and various surgical spinal disorders. [18][19][20][21][22][23][24][25][26] For example, preoperative anemia has been stated to be correlated with reintubation after anterior cervical fusion, perioperative visual loss after spinal fusion, and a signifi cantly increased risk of deep vein thrombosis and pulmonary embolism after lumbar spine surgery. 22 , 24 , 25 However, this study indicates that these anemia codes, originally developed for the purposes of reimbursement Female and billing, may not capture the quality of data necessary for making such clinical conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the manner in which current studies investigating the relationship between spinal pathologies and anemia in the NIS use the defi ciency anemia variable. [18][19][20][21][22][23][24][25][26] …”

Section: Methodsmentioning

confidence: 99%

Administrative Database Concerns

Golinvaux

Bohl

Basques

et al. 2014

Spine

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This study uses preoperative anemia to demonstrate the potential inaccuracies of ICD-9 coding. These results have implications for publications using databases that are compiled from ICD-9 coding data. Furthermore, the findings of the current investigation raise concerns regarding the accuracy of additional comorbidities. Although administrative databases are powerful resources that provide large sample sizes, it is crucial that we further consider the quality of the data source relative to its intended purpose.

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Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion

Cited by 93 publications

References 24 publications

Low-Dose Dexmedetomidine Accelerates Gastrointestinal Function Recovery in Patients Undergoing Lumbar Spinal Fusion

Low-Dose Dexmedetomidine Accelerates Gastrointestinal Function Recovery in Patients Undergoing Lumbar Spinal Fusion

Causes of 30-day readmission after neurosurgery of the spine

Administrative Database Concerns

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