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Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion.
Spine (Phila Pa 1976) 2014; 39(8):688-94S

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF).

SUMMARY OF BACKGROUND DATA

POI is frequently observed in anterior lumbar interbody fusion due to significant bowel manipulation during the approach. LLIF is a minimally invasive approach to the anterior column with reduced bowel manipulation and surgical time. However, there is a paucity of literature on POI after LLIF.

METHODS

A retrospective review was performed of records of patients who underwent LLIF from January 2006 to December 2011 at a single institution. Patients with prolonged and recurrent POI were identified by review of hospital stay documentation by a fellowship-trained spine surgeon and a research fellow. POI patients were matched 1:1 to a control cohort without POI. Uni- and multivariate analyses were performed on demographic, comorbidity, surgical indication, medication, and perioperative details to identify independent risk factors for POI.

RESULTS

Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Postoperative length of stay was significantly higher for patients with POI (9.9 ± 4.3 d) than control patients (5.6 ± 4.1 d) (P < 0.001). The incidence of ileus in the first 100 LLIF cases (11%) was not significantly higher than in the last 100 LLIF cases (6%) (P = 0.21). Independent risk factors were history of gastroesophageal reflux disease (P < 0.01, adjusted odds ratio [aOR]: 24.31), posterior instrumentation (P = 0.002, aOR: 19.48), and LLIF at L1-L2 (P = 0.04, aOR: 7.82). A history of prior abdominal surgery approached significance as an independent protective factor (P = 0.07, aOR: 0.29).

CONCLUSION

There was a relatively high incidence of POI after LLIF. Independent risk factors for POI were a history of gastroesophageal reflux disease, posterior instrumentation, and LLIF at L1-L2. A history of prior abdominal surgery approached significance as an independent protective factor.

LEVEL OF EVIDENCE

3.

Authors+Show Affiliations

From the Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24480952

Citation

Al Maaieh, Motasem A., et al. "Multivariate Analysis On Risk Factors for Postoperative Ileus After Lateral Lumbar Interbody Fusion." Spine, vol. 39, no. 8, 2014, pp. 688-94.
Al Maaieh MA, Du JY, Aichmair A, et al. Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. Spine. 2014;39(8):688-94.
Al Maaieh, M. A., Du, J. Y., Aichmair, A., Huang, R. C., Hughes, A. P., Cammisa, F. P., ... Sama, A. A. (2014). Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. Spine, 39(8), pp. 688-94. doi:10.1097/BRS.0000000000000238.
Al Maaieh MA, et al. Multivariate Analysis On Risk Factors for Postoperative Ileus After Lateral Lumbar Interbody Fusion. Spine. 2014 Apr 15;39(8):688-94. PubMed PMID: 24480952.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. AU - Al Maaieh,Motasem A, AU - Du,Jerry Y, AU - Aichmair,Alexander, AU - Huang,Russel C, AU - Hughes,Alexander P, AU - Cammisa,Frank P, AU - Girardi,Federico P, AU - Sama,Andrew A, PY - 2014/2/1/entrez PY - 2014/2/1/pubmed PY - 2014/12/17/medline SP - 688 EP - 94 JF - Spine JO - Spine VL - 39 IS - 8 N2 - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF). SUMMARY OF BACKGROUND DATA: POI is frequently observed in anterior lumbar interbody fusion due to significant bowel manipulation during the approach. LLIF is a minimally invasive approach to the anterior column with reduced bowel manipulation and surgical time. However, there is a paucity of literature on POI after LLIF. METHODS: A retrospective review was performed of records of patients who underwent LLIF from January 2006 to December 2011 at a single institution. Patients with prolonged and recurrent POI were identified by review of hospital stay documentation by a fellowship-trained spine surgeon and a research fellow. POI patients were matched 1:1 to a control cohort without POI. Uni- and multivariate analyses were performed on demographic, comorbidity, surgical indication, medication, and perioperative details to identify independent risk factors for POI. RESULTS: Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Postoperative length of stay was significantly higher for patients with POI (9.9 ± 4.3 d) than control patients (5.6 ± 4.1 d) (P < 0.001). The incidence of ileus in the first 100 LLIF cases (11%) was not significantly higher than in the last 100 LLIF cases (6%) (P = 0.21). Independent risk factors were history of gastroesophageal reflux disease (P < 0.01, adjusted odds ratio [aOR]: 24.31), posterior instrumentation (P = 0.002, aOR: 19.48), and LLIF at L1-L2 (P = 0.04, aOR: 7.82). A history of prior abdominal surgery approached significance as an independent protective factor (P = 0.07, aOR: 0.29). CONCLUSION: There was a relatively high incidence of POI after LLIF. Independent risk factors for POI were a history of gastroesophageal reflux disease, posterior instrumentation, and LLIF at L1-L2. A history of prior abdominal surgery approached significance as an independent protective factor. LEVEL OF EVIDENCE: 3. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/24480952/Multivariate_analysis_on_risk_factors_for_postoperative_ileus_after_lateral_lumbar_interbody_fusion_ L2 - http://Insights.ovid.com/pubmed?pmid=24480952 DB - PRIME DP - Unbound Medicine ER -