Incidence and Risk of Severe Ileus after Orthopedic Surgery: A Case-Control Study. Issue 2 (December 2020)

• Record Type: Journal Article
• Authors: Mandl, Lisa A.; Sasaki, Mayu; Yang, Jingyan; Choi, Sara; Cummings, Kelianne; Goodman, Susan M.
• Is Part Of: HSS journal. Volume 16:Issue 2(2020)Supplement
• Page Start: 272
• Page End: 279
• Publication Date: 2020-12
• Subjects: case-control studies -- incidence -- risk factors -- orthopedics -- ileus -- diet -- hospitalists; Musculoskeletal system -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; Musculoskeletal System -- surgery -- Periodicals; Orthopedic Procedures -- Periodicals; Orthopédie -- Périodiques; Appareil locomoteur -- Maladies -- Périodiques; Appareil locomoteur -- Maladies -- Patients -- Réadaptation -- Périodiques; 617.47005
• DOI: 10.1007/s11420-019-09712-z
• Languages: English
• ISSNs: 1556-3316

Abstract

Background: Post-operative ileus (POI) is common and can be associated with significant morbidity. Questions/Purposes: We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. Methods: We conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. Results: Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. Conclusions: In this retrospective case–control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.