title: Constipation after thoraco-lumbar fusion surgery.
abstract: BACKGROUND
  Thoraco-lumbar posterior fusion surgery is a frequent procedure used for patients with spinal instability due to tumor, trauma or degenerative disease. In the perioperative phase, many patients may experience vomiting, bowel irritation, constipation, or may even show symptoms of adynamic ileus possibly due to immobilization and high doses of opioid analgesics and narcotics administered during and after surgery.
  
  
  METHODS
  Retrospective single-center study on patients undergoing thoraco-lumbar fusion surgery for degenerative lumbar spine disease with instability in 2012. Study groups were built according to presence/absence of postoperative constipation, with postoperative constipation being defined as no bowel movement on postoperative days 0-2.
  
  
  RESULTS
  Ninety-nine patients (39 males, 60 females) with a mean age of 57.1 ± 17.3 years were analyzed, of which 44 patients with similar age, gender, BMI and ASA-grades showed constipation (44.4%). Occurrence of constipation was associated with longer mean operation times (247 ± 62 vs. 214 ± 71 min; p=0.012), higher estimated blood loss (545 ± 316 vs. 375 ± 332 ml; p<0.001), and higher mean morphine dosages in the postoperative days 0-7 (the difference being significant on postoperative days 1 (48 mg vs. 30.9 mg, p=0.041) and 2 (43.2mg vs. 29.1mg, p=0.028). The equivalence dose of morphine administered during surgery was similar (339 ± 196 vs. 285 ± 144 mg; p=0.286). The use of laxatives in the postoperative days 0-7 was generally high in both study groups, while it was more frequent in patients experiencing constipation. One patient with constipation developed a sonographically confirmed paralytic ileus. Patients with constipation showed a tendency toward longer postoperative hospitalization (7.6 vs. 6.7 days, p=0.136).
  
  
  CONCLUSIONS
  The rate of constipation was high after thoraco-lumbar fusion surgery. Moreover, it was associated with longer surgery time, higher blood loss, and higher postoperative morphine doses. Further trials are needed to prove if the introduction of faster and less invasive surgery techniques may have a positive side effect on bowel movement after spine surgery as they may reduce operation times, blood loss and postoperative morphine use.
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland. Electronic address: mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Frankston Hospital, Department of Surgery, Melbourne, Australia.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.affiliation: Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Enrico
authors.initials: E
authors.lastname: Tessitore
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
mesh_terms: D000328:Adult; D000368:Aged; D003248:Constipation / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009022:Morphine Derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D013904:Thoracic Vertebrae / Q000601:surgery
chemical_list: D009022:Morphine Derivatives
keywords: Bowel movement; Constipation; Gastrointestinal morbidity; Lumbar fusion surgery; Outcome