Risk Factors For Ileus Research Articles

1065 Exposing the Incidence of Ileus in Pelvic and Acetabular Fractures: A Retrospective Case Analysis

Abstract Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

Exposing the incidence of ileus in pelvic and acetabular fractures: a retrospective case analysis

BackgroundParalytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. Prior to this study, there were no reported figures for the incidence of ileus in patients presenting with pelvic and/or acetabular fractures. MethodsAll patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data collected included patient demographics, injury pattern, fracture management and presence of ileus. As in previous studies, patients were identified as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. ResultsAn incidence of ileus of 40.35% was observed in the 57 included patients. Across all patients, ileus was three times more common in patients with a diagnosis of diabetes mellitus (p= 0.56) and 2.5 times more common in the presence of an open pelvic/ acetabular fracture (p= 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p= 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors for ileus. Conclusion/ FindingsThis is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Due to the morbidity and cost associated with this condition, further research is required to assess the effect of interventions to reduce its incidence in this patient subgroup.

Risk factors for ileus after hip and knee arthroplasty.

Postoperative ileus (POI) is one of the complications that can occur after every surgical procedure including arthroplasty. It can have detrimental consequences for the patient and portrays an economic burden on health care systems. The risk factors for POI after arthroplasty described in the literature are scarce and include hip arthroplasty, male gender and previous abdominal surgery. The purpose of the study was to determine the risk factors for POI after hip and knee arthroplasty. A retrospective review of 2760 patients undergoing primary hip and knee arthroplasty was performed. An in-depth analysis of patient history and physical operative and postoperative course was reviewed and statistically analyzed in a univariate and multivariate setting. Overall incidence of POI was 0.54%. History of myocardial infarction and chronic kidney disease were statistically significant risk factors for developing POI after arthroplasty with values of p= 0.023 and p= 0.004, respectively. Other risk factors included previous abdominal surgery (p< 0.001) and hip arthroplasty (p= 0.026). Age or gender correlations were not observed. Although postoperative ileus is an uncommon complication after joint arthroplasty, in addition to the known risk factors of male age, hip arthroplasty, and previous abdominal surgery, this study describes two previously unknown risk factors: chronic kidney disease and history of myocardial infarction. Patients with these risk factors should be monitored closely for developing postoperative ileus.

Risk Factors for Postoperative Ileus after Scoliosis Surgery.

Introduction One complication after scoliosis surgery is ileus; however, few reports have described the frequency of and risk factors for this complication. We conducted a retrospective clinical study with logistic regression analysis to confirm the frequency of and risk factors for ileus after scoliosis surgery. Methods After a retrospective review of data from patients who underwent surgical correction of spinal deformity from 2009 to 2014, 110 cases (age range, 4-73 yr; median, 14 yr) were included in the study. We defined postoperative ileus (POI) as a surgical complication characterized by decreased intestinal peristalsis and the absence of stool for more than 3 days postoperatively. Various parameters were compared between patients with POI and those without POI. Logistic regression analysis was performed to assess the risk factors associated with ileus; a P value of <0.05 was considered statistically significant. Results Fifteen of 110 (13.6%) cases developed POI. The median height, weight, operation time, and blood loss volume of the patients with versus without POI were 146 versus 152 cm, 39.0 versus 44.0 kg, 387 versus 359 min, and 1590 versus 1170 g, respectively. There were no significant differences between patients with versus without POI in the measured parameters, with the exception of patient height, bed rest period, and presence of neuromuscular scoliosis. Multiple logistic regression analysis revealed neuromuscular scoliosis as a significant risk factor for POI (odds ratio, 4.21; 95% CI, 1.23-14.40). Conclusions Our findings indicate a high probability of POI after scoliosis surgery, with an incidence of 13.6%. Neurogenic scoliosis, but not lowest instrumented vertebra or correction rate, was a risk factor for POI after scoliosis surgery. Digestive symptoms should be carefully monitored after surgery, particularly in patients with neuromuscular scoliosis.

Clozapine-induced paralytic ileus: a case report.

Ileus is the disruption of the normal propulsive ability of the gastrointestinal tract and it represents 20% of acute abdominal pain cases. Renal failure, hypovolemic shock, organ hypoperfusion, bowel perforation, peritonitis and sepsis, are serious and potentially fatal consequences of ileus. All of the psychotropic drugs with anticholinergic side effects can result in a change in bowel movements which may result in paralytic ileus. Paralytic ileus cases have been reported related to the anticholinergic side effects in the use of antidepressants such as amitriptyline, clomipramine and imipramine; and first-generation antipsychotics such as chlorpromazine, thioridazine and flupenthixol. Second-generation antipsychotics can cause a very rare paralytic ileus [Luzny et al. 2010; Rondla and Crane 2007; Giordano et al. 1975; Gaszner et al. 2004; Hayes et al. 1987; Fayad and Brujinzeel, 2012; Ramamourthy et al. 2013]. In the literature, advanced age, female gender, first-generation antipsychotics, tricyclic antidepressants, anticholinergics and opioids are reported as risk factors for ileus in patients with schizophrenia [Nielsen and Meyer, 2012]. The main reason for ileus being associated with clozapine is the muscarinic anticholinergic activity of clozapine. It has been also suggested that clozapine may induce an infection or ileus may develop depending on the dose of the toxicity [Rondla and Crane 2007; Nielsen and Meyer, 2012; Darling and Huthwaite, 2011; Solanki et al. 2007]. Indeed, after the treatment of animal models with antipsychotics, bowel structure inflammation, edema and bleeding have been reported in the intestinal structure [Luzny et al. 2010; Rondla and Crane, 2007]. Another present mechanism is the immobility caused by the H1 antagonism. 5HT receptors which are effective in gastrointestinal motility may also be effective in the etiology [Nielsen and Meyer, 2012]. A schizophrenic patient who developed paralytic ileus after the use of clozapine has been presented as a case study below.

Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion

Background contextPostoperative ileus is a known complication of surgery. The incidence and risk factors for ileus after lumbar fusion surgery is not well characterized. PurposeTo determine rates of postoperative ileus, a population-based database was analyzed to identify incidence, mortality, and risk factors associated with anterior (ALF), posterior (PLF), and combined anterior/posterior (APLF) lumbar fusions. Study designThis was a retrospective database analysis. Patient sampleThe sample consisted of 220,522 patients from the Nationwide Inpatient Sample (NIS) database. Outcome measuresOutcome measures were incidence of postoperative ileus, length of stay (LOS), in-hospital costs, and mortality. MethodsData from the NIS were obtained from 2002 to 2009. Patients undergoing ALF, PLF, and APLF for degenerative pathologies were identified and the incidence of postoperative ileus was assessed. Patient demographics, Charlson comorbidity index (CCI), LOS, costs, and mortality were assessed. SPSS v.20 was used to detect statistical differences between groups and perform logistic regression analyses to identify independent predictors of postoperative ileus. A p value less than .001 denoted significance. ResultsA total of 220,522 lumbar fusions were identified in the United States from 2002 to 2009. There were 19,762 ALFs, 182,801 PLFs, and 17,959 APLFs. The incidence of postoperative ileus was increased in ALFs over PLFs (74.9 vs. 26.0 per 1,000; p<.001). Within PLF and APLF groups, CCI scores were increased in the presence of postoperative ileus (p<.001). Across cohorts, patients with postoperative ileus demonstrated greater LOS and costs (p<.001). PLF-treated patients with postoperative ileus demonstrated increased mortality (p<.001). Independent predictors of postoperative ileus included male gender, 3+ fusion levels, alcohol abuse, anemia, fluid/electrolyte disorders, and weight loss (p<.001). ConclusionsThe results of our study demonstrate increased incidence of postoperative ileus associated with anterior approaches for lumbar fusion. Across cohorts, postoperative ileus was associated with increased LOS and costs. To determine the mortality and resource use associated with postoperative ileus, we recommend preoperatively identifying and treating modifiable risk factors, especially when an anterior approach is used.

Risk Factors for Ileus in Patients with Schizophrenia

Constipation is a known side effect of psychotropics that possess high affinity for muscarinic cholinergic receptors. In severe cases, constipation progresses to ileus and bowel ischemia, with multiple fatalities related to sepsis and perforation described in the literature, primarily among patients with schizophrenia. A historical prospective database study was performed using registry data from psychiatric and somatic hospitals, combined with the prescription database to examine associations between medications and ileus. Only cases with an ICD-10 diagnosis of schizophrenia (F20) and a concurrent diagnosis of ileus in the years 1996-2007 were included in the study. A total of 26,720 patients with schizophrenia were identified with 123 cases of ileus noted in the study period. Increasing age (OR: 1.03 CI: 1.01-1.04) and female sex (OR: 1.60 CI: 1.10-2.31) were associated with an increased risk of ileus. Treatment with clozapine (OR: 1.99 CI: 1.21-3.29), high-potency first-generation antipsychotics (OR: 1.81 CI: 1.01-3.23), tricyclic antidepressants (OR: 2.29 CI: 1.29-4.09), anticholinergics (OR: 1.48 CI: 1.00-2.19), and opioids (OR: 2.14 CI: 1.36-3.36) were associated with an increased risk of ileus. The onset of ileus occurred on average more than 3 years after the first prescription of the offending drug. Aripiprazole and amisulpride were not associated with ileus. Nine of the ileus cases (7.3%) had a fatal course. Treatment with clozapine (OR: 6.73 CI: 1.55-29.17) or anticholinergics (OR: 5.88 CI: 1.47-23.58) were associated with increased risk of fatal ileus. Patients receiving psychotropics associated with significant anticholinergic properties should undergo proper monitoring and interventions in order to minimize the burden of constipation and the risk of ileus.

Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse

The aims of this secondary analysis of the "Colpopexy And Urinary Reduction Efforts" (CARE) study were to estimate the incidence of postoperative gastrointestinal complications and identify risk factors. We prospectively identified gastrointestinal complications and serious adverse events (SAE) for 12 months after sacrocolpopexy. Two surgeons independently reviewed reports of ileus or small bowel obstruction (SBO). Eighteen percent of 322 women (average age 61.3 years) reported "nausea, emesis, bloating, or ileus" during hospitalization and 9.8% at 6 weeks. Nineteen women (5.9%; CI 3.8%, 9.1%) had a possible ileus or SBO that generated SAE reports: 4 (1.2%, CI 0.5%,3.2%) were reoperated for SBO, 11 (3.4%, CI 1.9%,6.1%) were readmitted for medical management, and 4 had a prolonged initial hospitalization. Older age (P < .001) was a risk factor for ileus or SBO. One in 20 women experiences significant gastrointestinal morbidity after sacrocolpopexy. This information will aid preoperative counseling.

Risk Factors of Ileus following Radical Cystectomy

Purpose: Ileus is the most common complication following radical cystectomy. Ileus causes prolonged fasting, significant patient discomfort and prolongation of the hospital stay. We retrospectively examined the risk factors for ileus following radical cystectomy. Materials and Methods: Between January, 2000 and June, 2007, 59 patients underwent radical cystectomy with urinary diversion at our institution. 30 patients underwent creation of an ileal conduit and 29 patients underwent orthotopic bladder substitution with using ileum. Ileus was defined as the persistent absence of flatus on postoperative day 7 or the generalized findings of ileus on simple abdominal film. The potential risk factors were analyzed between the ileus and non ileus groups, including the patient's age and gender, the American Society of Anesthesiologists score, the preoperative serum albumin level, prior abdominal surgery, the operative time, combined operation, the estimated blood loss, the type of urinary diversion, use of N2O, use of intestinal stapler, complications, the ICU stay and the pathologic stage and grade. Results: 24% (14/59) of patients had postoperative ileus. The difference of the ASA score between the two groups was statistically significant (p=0.03). Patients with ileus (67.5±7.2) were older than the non-ileus patients (63.0±9.4) (p=0.103). Ileus was more frequent in men (29.5%, 13/ 44) than in women (6.6%, 1/15) (p=0.09). Conclusions: Ileus following radical cystectomy was more frequent in patients with a high ASA score. Older aged men tend to have ileus after radical cystectomy. (Korean J Urol 2007;48:1236-1241) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Is phototherapy a risk factor for ileus in high-risk neonates?

Background. Abdominal distension and bile stained aspirates are common in high-risk neonates under phototherapy (PT).Objective. To compare the incidence of ileus and related risk factors in extremely low birth weight (ELBW) neonates who did/did not receive PT.Design/methods. Retrospective detailed analysis of data on 52 consecutive ELBW neonatal admissions (1997–1999) including demographic characteristics, outcomes to discharge and common risk factors for ileus such as intrauterine growth retardation, PDA, indomethacin therapy, sepsis and enteral feeds. Ileus was defined as presence of abdominal distension and bile stained aspirate/s with/without dilated bowel loops on X-rays.Results. A significantly (p = 0.001) higher proportion (63.4%, 26/41) of neonates under PT developed ileus than those (1/11) who did not receive PT. The outcomes and risk factors for ileus were comparable between the two groups. Mean (±SD) gestational age and birth weight of those who did and did not receive PT [26 (±2.2) weeks and 803 (±133) grams vs. 27 (±3.2) weeks and 664 (±114.2) grams], and those who did and did not develop ileus [26.5 (±2.3) weeks and 797 (±102) grams vs. 28.0 (±1.2) weeks and 750 (±105) grams] were not significantly different.Conclusion. Phototherapy may be an independent risk factor for ileus in ELBW neonates.