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Multivariate Analysis on Risk Factors for Post-Operative Ileus After Lateral Lumbar Interbody Fusion.

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Multivariate Analysis on Risk Factors for Post-Operative Ileus After Lateral Lumbar Interbody Fusion.

Spine (Phila Pa 1976). 2014 Jan 29;

Authors: Al Maaieh MA, Du JY, Aichmair A, Huang RC, Hughes AP, Cammisa FP, Girardi FP, Sama AA

Abstract
STRUCTURED ABSTRACT: Study Design. Retrospective Cohort StudyObjective. To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF).Summary of Background Data. POI is frequently observed in anterior lumbar interbody fusion (ALIF) 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 multi-variate analyses were performed on demographic, co-morbidity, surgical indication, medication, and peri-operative details to identify independent risk factors for POI.Results. Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Post-operative length of stay was significantly higher for POI patients (9.9±4.3 days) compared to control patients (5.6±4.1 days) (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 GERD (p<0.01, adjusted odds ratio (aOR): 24.31), posterior instrumentation (p = 0.002, aOR: 19.48), and LLIF at L1-2 (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 GERD, posterior instrumentation, and LLIF at L1-2. A history of prior abdominal surgery approached significance as an independent protective factor.

PMID: 24480952 [PubMed – as supplied by publisher]

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