Abstract
BackgroundPost-operative ileus (POI) is common and can be associated with significant morbidity.Questions/PurposesWe aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery.MethodsWe conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI.ResultsOf 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI.ConclusionsIn this retrospective case–control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.
Highlights
Post-operative ileus (POI) has been reported in 0.7 to 4% of orthopedic surgery patients [11]
The purpose of this study was to answer the following four questions: (1) What is the incidence of severe postoperative ileus (SPOI) after elective orthopedic procedures? (2) What are the univariate associations of potential associated risk factors for SPOI after these procedures? (3) What are the multivariate associations of potential associated risk factors for SPOI after these procedures? (4) What are the adverse events associated with SPOI after these procedures?
For this retrospective case–control study, all elective and nonemergent orthopedic procedures performed at a single musculoskeletal specialty hospital between March 2009 and April 2011 were eligible for inclusion
Summary
Post-operative ileus (POI) has been reported in 0.7 to 4% of orthopedic surgery patients [11]. Severe post-operative ileus (SPOI) is associated with an increase in venous thromboembolism, variability in dose response to warfarin, and even colonic perforation and death [2, 4, 9, 12]. Prior abdominal surgery, prolonged operative time, and prolonged opioid use have been reported as risk factors for POI in orthopedic surgery, these have been inconsistently described [10]. Post-operative ileus (POI) is common and can be associated with significant morbidity. Questions/Purposes: We aimed to identify the incidence of and risk factors associated with severe postoperative ileus (SPOI) after elective orthopedic surgery. Methods: We conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital.
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