Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion.
METHODS
Retrospective cohort study.


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


BACKGROUND
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).


CONCLUSIONS
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.


METHODS
3.
From the Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.
Motasem A
MA
Al Maaieh
Jerry Y
JY
Du
Alexander
A
Aichmair
Russel C
RC
Huang
Alexander P
AP
Hughes
Frank P
FP
Cammisa
Federico P
FP
Girardi
Andrew A
AA
Sama
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D045823:Ileus / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome