title: Preoperative bowel preparation versus no preparation before spinal surgery: A randomised clinical trial.
abstract: OBJECTIVE
  To investigate the effect of preoperative bowel preparation for patients undergoing spinal fusion surgery.
  
  
  BACKGROUND
  Bowel preparation before major surgery is performed routinely to reduce the risk of postoperative complications related to gastrointestinal function.
  
  
  METHODS
  A randomised clinical trial was performed that included forty-five elective spinal fusion patients allocated to one control group and two treatment groups. The patients received preoperative bowel preparation with enema, suppository or no bowel preparation. The outcome measures were defecation within 72 hours postoperatively, defecation on the fifth postoperative day, postoperative constipation, nausea, pain, well-being and ambulation.
  
  
  RESULTS
  There were significant differences in favour of no bowel preparation compared with suppository group for the primary outcome; days to first defecation. There was a tendency for the patients who received no bowel preparation to recover from constipation more quickly than patients in the bowel preparation groups. The majority of patients did not defecate until the fourth postoperative day.
  
  
  CONCLUSIONS
  This randomised study found no benefit from bowel preparation before major spine surgery on gastrointestinal function. The use of bowel preparation is not evidence-based and not performing it should be considered before major spine surgery until the effect is known.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo Universitetssykehus HF, PB 4953 Nydalen, Norway; Lovisenberg Diaconal University College, Lovisenbergt. 15b, 0456 Oslo, Norway. Electronic address: unni.olsen@ldh.no.
authors.forename: Unni
authors.initials: U
authors.lastname: Olsen
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo Universitetssykehus HF, PB 4953 Nydalen, Norway.
authors.forename: Jens Ivar
authors.initials: JI
authors.lastname: Brox
authors.affiliation: Institute of Health and Society, University of Oslo, Postbox 1130 Blindern, 0318 Oslo, Norway.
authors.forename: Ida Torunn
authors.initials: IT
authors.lastname: Bjørk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003248:Constipation / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D013119:Spinal Cord Injuries / Q000451:nursing / Q000601:surgery*; D013123:Spinal Fusion; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bowel preparation; Constipation; Enema; Ileus; Postoperative care; Postoperative complication; Spinal fusion