J Neurogastroenterol Motil.  2015 Jan;21(1):121-125. 10.5056/jnm14077.

Risk Factors for Postoperative Ileus Following Orthopedic Surgery: The Role of Chronic Constipation

Affiliations
  • 1Nutritional Support Team, Soonchunhyang University Seoul Hospital, Seoul, Korea.
  • 2Institute for Digestive Research, Soonchunhyang University, College of Medicine, Seoul, Korea. joonlee@schmc.ac.kr
  • 3Department of Anesthesiology and Pain Medicine, Soonchunhyang University, College of Medicine, Seoul, Korea.
  • 4Department of Orthopedic Surgery, Soonchunhyang University, College of Medicine, Seoul, Korea.
  • 5Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Seoul, Korea.

Abstract

BACKGROUND/AIMS
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 compared 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/m2), 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.

Keyword

Ileus; Orthopedics; Risk factors

MeSH Terms

Body Mass Index
Constipation*
Diet
Flatulence
Humans
Ileus*
Intestinal Pseudo-Obstruction
Laxatives
Logistic Models
Orthopedics*
Retrospective Studies
Risk Factors*
Laxatives
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