title: The incidence and risk factors for post-operative ileus after spinal fusion surgery: a multivariate analysis.
abstract: Post-operative ileus is a recognized complication of surgery. Little is known about the incidence and risk factors for post-operative ileus following spinal fusion surgery. To report the incidence and to assess for independent risk factors of post-operative ileus after spinal fusion surgery.
  
  
  
  Retrospective single-centre cohort study. Patients with prolonged or recurrent post-operative ileus were identified by review of hospital stay documentation. Patients with post-operative ileus were matched 1:2 to a control cohort without post-operative ileus. Uni and multi variate analyses were performed on demographic, comorbidity, surgical indication, medication, and peri-operative details to identify risk factors for post-operative ileus.
  
  
  
  Two thousand six hundred and twenty five patients underwent spinal fusion surgery between January 2012 and December 2012. Forty nine patients with post-operative ileus were identified (1.9 %). Post-operative length of hospital stay was significantly longer for patients with post-operative ileus (9.3 ± 5.2 days), than control patients (5.5 ± 3.2 days) (p < 0.001). Independent risk factors were Lactated Ringers solution (aOR: 2.12, p < 0.001), 0.9 % NaCl solution (aOR: 2.82, p < 0.001), and intra-operative hydromorphone (aOR: 2.31, p < 0.01) and a history of gastro-oesophageal reflux (aOR: 4.86, p = 0.03). Albumin administration (aOR: 0.09, p < 0.01) was protective against post-operative ileus.
  
  
  
  Post-operative ileus is multifactorial in origin, and this study identified intra-operative hydromorphone and post-operative crystalloid fluid administration ≥2 litres as independent risk factors for the development of ileus.
authors.affiliation: Nicklaus Childrens Hospital, 3100 SW 62 Avenue, Miami, FL, 33155, USA. paul.kiely@aol.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Kiely
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Mount
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Jerry Y
authors.initials: JY
authors.lastname: Du
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Gil
authors.initials: G
authors.lastname: Weitzman
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Stavros
authors.initials: S
authors.lastname: Memstoudis
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waldman
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Lebl
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D045823:Ileus / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: Incidence; Postoperative ileus; Risk factors; Spinal fusion