title: Risk factors for postoperative ileus following orthopedic surgery: the role of chronic constipation.
abstract: OBJECTIVE
  Distinction is vague between severe constipation and postoperative ileus (POI) in terms of pathogenesis, clinical features, and treatment options. However, no data are available regarding their associations.
  
  
  METHODS
  After retrospective review of data from patients who underwent orthopedic surgery during the first 6 months of 2011, a total of 612 patients were included. Severe constipation was defined as symptoms of constipation requiring treatment using at least 2 laxatives from different classes for at least 6 months. POI was defined as paralytic ileus lasting more than 3 days post-surgery and associated with 2 or more of the following: (1) nausea/vomiting, (2) inability to tolerate an oral diet over a 24-hour period, and (3) absence of flatus over a 24-hour period. The subjects were divided into non-POI and POI groups, and we com - pared patient-, surgery-, and pharmaceutical-related factors.
  
  
  RESULTS
  Thirteen (2.1%) out of 612 experienced POI. In comparisons between the non-POI and POI groups, univariate analysis showed significant differences in the mean age (51.4 vs. 71.6 years), mean body mass index (24.1 vs. 21.8 kg/m(2)), severe constipation (5.8% vs. 76.9%), co-morbidities (33.2% vs. 84.6%), type of orthopedic surgery (spine/hip/limb: 19.4/11.0/65.6% vs. 23.1/61.5/15.4%), and estimated blood loss (50 vs. 300 mL). Multivariate logistic regression analysis, after adjustment for age, body mass index, co-morbidities, type of orthopedic surgery, and estimated blood loss, showed that severe constipation was an independent risk factor for POI (OR 35.23; 95% CI, 7.72-160.82; P < 0.001).
  
  
  CONCLUSIONS
  Severe constipation is associated with POI after orthopedic surgery.
authors.affiliation: Nutritional Support Team, Soonchunhyang University Seoul Hospital, Seoul, Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Nutritional Support Team, Soonchunhyang University Seoul Hospital, Seoul, Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Nutritional Support Team, Soonchunhyang University Seoul Hospital, Seoul, Korea.
authors.forename: Seong Ran
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Nutritional Support Team, Soonchunhyang University Seoul Hospital, Seoul, Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Byun
authors.affiliation: Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Park
authors.affiliation: Departments of Anesthesiology and Pain Medicine, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Soon Im
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Departments of Surgery, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Choi
authors.affiliation: Departments of Surgery, Soonchunhyang University, College of Medicine, Seoul, Korea.
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Lee
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
keywords: Ileus; Orthopedics; Risk factors