Ileus and Gastrointestinal Complications

Abstract

Postoperative ileus (POI) is a normal, physiologic response of the gastrointestinal tract in the postoperative patient. However, when prolonged, it is a cause of significant patient morbidity, protracted hospital course, and increased healthcare costs. Prolonged POI is a known complication of spinal fusion and orthopedic surgery in general and occurs in part as a result of normal physiology but is also exacerbated by postoperative opioid use. There is an increasing body of literature on the subject of POI in this patient population; however, to date, there has been only one published study examining the incidence of and risk factors for POI following XLIF, and there is much to be learned about the factors that predispose patients undergoing spinal surgery to develop pathologic ileus. The management of POI in the postoperative patient undergoing spinal surgery is multifactorial and focuses on preventive measures and patient optimization, use of selective opioid antagonists, and utilization of alternative pain control methods to limit systemic opioids.