Risk Factors for Postoperative Ileus Following Orthopedic Surgery: The Role of Chronic Constipation

Abstract

Background/Aims Distinction is vague between severe constipation and postoperative ileus (POI) in terms of pathogenesis, clinical features, and treatment options. However, no data are available regarding their associations. Methods After retrospective review of data from patients who underwent orthopedic surgery during the first 6 months of 2011, a total of 612 patients were included. Severe constipation was defined as symptoms of constipation requiring treatment using at least 2 laxatives from different classes for at least 6 months. POI was defined as paralytic ileus lasting more than 3 days post-surgery and associated with 2 or more of the following: (1) nausea/vomiting, (2) inability to tolerate an oral diet over a 24-hour period, and (3) absence of flatus over a 24-hour period. The subjects were divided into non-POI and POI groups, and we compared patient-, surgery-, and pharmaceutical-related factors. Results Thirteen (2.1%) out of 612 experienced POI. In comparisons between the non-POI and POI groups, univariate analysis showed significant differences in the mean age (51.4 vs 71.6 years), mean body mass index (24.1 vs 21.8 kg/m 2 ), severe constipation (5.8% vs 76.9%), co-morbidities (33.2% vs 84.6%), type of orthopedic surgery (spine/hip/limb: 19.4/11.0/65.6% vs 23.1/61.5/15.4%), and estimated blood loss (50 vs 300 mL). Multivariate logistic regression analysis, after adjustment for age, body mass index, co-morbidities, type of orthopedic surgery, and estimated blood loss, showed that severe constipation was an independent risk factor for POI (OR, 35.23; 95% CI, 7.72–160.82; P < 0.001). Conclusions Severe constipation is associated with POI after orthopedic surgery.

Proposal of a new classification of postoperative ileus based on its clinical impact—results of a global survey and preliminary evaluation in colorectal surgery

“…Various factors, such as constipation, influence the time to bowel motility recovery, which leads to a possible misinterpretation of these factors as risk factors for POI [21]. As such, we believe that a classification of POI should be based on consequences rather than delay.…”

Risk Factors for Postoperative Ileus after Scoliosis Surgery

“…Few studies have focused on the risk factors for POI following scoliosis surgery. Most have reported the incidence of POI following spine surgery, which ranges from 0.6% to 16.7% [8][9][10][11] . The present study is the first to identify the incidence of and risk factors for POI after scoliosis surgery, and it revealed two important findings.…”

“…Multiple studies have evaluated the risk factors for POI following spine surgery. Such risk factors include a low body mass index, general anesthesia, gastroesophageal reflux disease, intraoperative administration of >2 L/day of crystalloid solutions, and severe constipation 9,10,12,13) . In the present study, the presence of NMS was identified as the main risk factor for POI following scoliosis surgery.…”

Antacid attenuates the laxative action of magnesia in cancer patients receiving opioid analgesic

“…It has been reported that higher performance status is associated with more severe constipation in patients receiving opioid analgesic agents . Moreover, surgical operation often causes constipation, which becomes a risk for postoperative ileus …”

“…[15] Moreover, surgical operation often causes constipation, which becomes a risk for postoperative ileus. [16] This study was conducted according to the guidelines for human studies determined by the Ethical Committee of Gifu University Graduate School of Medicine and the Government of Japan, and was approved by the Medical Review Board of Gifu University Graduate School of Medicine (approval no. 28-87).…”