Risk Factors, Additional Length of Stay, and Cost Associated with Postoperative Ileus Following Anterior Lumbar Interbody Fusion in Elderly Patients

Horowitz, Jason A.; Jain, Amit; Puvanesarajah, Varun; Qureshi, Rabia; Hassanzadeh, Hamid

doi:10.1016/j.wneu.2018.04.006

Cited by 27 publications

(17 citation statements)

References 18 publications

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“…Our results also indicated that gender and operative segments were associated with duration to first flatus. Male gender was reported to be an independent risk factor for postoperative ileus in anterior lumber interbody fusion in the elderly (Horowitz et al, 2018). Surgeons should take the increased risks of postoperative ileus into account when selecting a surgical approach for a male patient.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…The prolonged length of stay following postoperative ileus is consistent with a previous study which found that elderly patients who underwent ALIF complicated by a postoperative ileus had a significantly greater length of hospital stay, which was associated with an additional healthcare cost of more than $2000. [ 21 ] However, our study did identify a nonsignificant increase in the frequency of LLIFs performed at L1-L2, possibly contributing to the number of patients who received abdominal scans since postoperative ileus is more commonly encountered after performing LLIFs at that level. [ 7 ] This data, in conjunction with previous literature, suggests that preoperative counseling of patients regarding the elevated risk of postoperative ileus for LLIFs performed at the L1-2 level is warranted.…”

Section: Discussionmentioning

confidence: 69%

An evaluation of patients with abdominal pain after lateral lumbar interbody fusion

Lambrechts

Fried

Tran

et al. 2022

J Craniovert Jun Spine

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Context Abdominal pain after surgery can occur for numerous reasons. Postoperative radiographs may be indicated to evaluate for ileus or other reasons for the pain. Whether outcomes are significantly different based on whether patients get radiographs following lateral lumbar interbody fusion (LLIF) are unclear. Aims: To investigate the postoperative outcomes of patients experiencing abdominal pain after LLIF. Settings and Design: This retrospective cohort study included patients at a tertiary academic medical center and surrounding affiliated hospitals. Materials and Methods: Patients >18 years of age who underwent elective LLIF at a single institution were retrospectively identified. Patients were stratified into two groups depending on whether they received a postoperative abdominal radiograph or computed tomography (CT) scan for postoperative abdominal pain. Statistical Analysis: Patient demographics, surgical characteristics, and surgical outcomes were compared between groups utilizing independent t -tests or Mann–Whitney U -tests for continuous variables or Pearson's Chi-square tests for categorical variables. Results: A total of 153 patients (18 with abdominal scans, 135 without) were included. Patients who received a postoperative abdominal radiograph or CT scan were more likely to undergo exploratory laparotomy (11.1% vs. 0.00%, P = 0.013). Ultimately, patients with abdominal scans had a longer hospital length of stay (6.67 vs. 3.79 days, P = 0.002) and were discharged home less frequently (71.4% vs. 83.7%, P = 0.002). Conclusions: Patients who received abdominal imaging after LLIF were more likely to undergo exploratory laparotomy, experience longer hospital length of stay, and were discharged home less frequently. Intra-abdominal air on postoperative imaging without corresponding physical exam findings consistent with bowel injury is not an appropriate indication for surgical intervention.

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“… 7–9 In patients undergoing anterior lumbar interbody fusion, POI can prolong hospital stay by 3 days and increase hospitalisation costs by $2400. 10 Reducing the mean length of hospital stay by just 1 day could reduce the cost of the healthcare system in the USA by approximately $1 billion annually. 11 This highlights the importance of treating and decreasing the duration of POI.…”

Section: Introductionmentioning

confidence: 99%

“…POI can lower patient satisfaction and quality of life, increase the risk of other postoperative complications, prolong hospital stay, and increase readmission rates and hospital costs 7–9. In patients undergoing anterior lumbar interbody fusion, POI can prolong hospital stay by 3 days and increase hospitalisation costs by $2400 10. Reducing the mean length of hospital stay by just 1 day could reduce the cost of the healthcare system in the USA by approximately $1 billion annually 11.…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture versus sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: study protocol for a multicentre, randomised, sham-controlled trial

et al. 2022

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IntroductionPostoperative ileus (POI) is an inevitable complication of almost all abdominal surgeries, which results in prolonged hospitalisation and increased healthcare costs. Various treatment strategies have been developed for POI but with limited success. Electroacupuncture (EA) might be a potential therapy for POI. However, evidence from rigorous trials that evaluated the effectiveness of EA for POI is limited. Thus, the aim of this study was to examine whether EA can safely reduce the time to the first defecation after laparoscopic surgery in patients with POI.Methods and analysisThis multicentre randomised sham-controlled trial will be conducted in four hospitals in China. A total of 248 eligible participants with colorectal cancer who will undergo laparoscopic surgery will be randomly allocated to an EA group and a sham EA group in a 1:1 ratio. Treatment will be performed starting on postoperative day 1 and continued for four consecutive days, once per day. If the participant is discharged within 4 days after surgery, the treatment will cease on the day of discharge. The primary outcome will be the time to first defecation. The secondary outcome measures will include time to first flatus, tolerability of semiliquid and solid food, length of postoperative hospital stay, postoperative nausea and vomiting, abdominal distension, postoperative pain, postoperative analgesic, time to first ambulation, blinding assessment, credibility and expectancy and readmission rate.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Beijing University of Chinese Medicine (number 2020BZHYLL0116) and the institutional review board of each hospital. The results will be disseminated through peer-reviewed publications. This study protocol (V.3.0, 6 March 2020) involves human participants and was approved by the ethics committees of Beijing University of Chinese Medicine (number 2020BZHYLL0116), Beijing Friendship Hospital Affiliated to Capital Medical University (number 2020-P2-069-01), Beijing Chao-Yang Hospital Affiliated to Capital Medical University (number 2020-3-11-2), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (number 20/163-2359), and the Affiliated Hospital of Qingdao University (number QYFYKYLL711311920). The participants gave informed consent to participate in the study before taking part.Trial registration numberChiCTR2000038444.

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Risk Factors, Additional Length of Stay, and Cost Associated with Postoperative Ileus Following Anterior Lumbar Interbody Fusion in Elderly Patients

Cited by 27 publications

References 18 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

An evaluation of patients with abdominal pain after lateral lumbar interbody fusion

Electroacupuncture versus sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: study protocol for a multicentre, randomised, sham-controlled trial

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