• Anna K Wright, Danielle La Selva, Louis Nkrumah, Vijay Yanamadala, Jean-Christophe Leveque, and Rajiv K Sethi.
• Neuroscience Institute, Virginia Mason Medical Center, Seattle, Washington, USA.
• World Neurosurg. 2019 Dec 1; 132: e618-e622.

BackgroundThe reported incidence of postoperative ileus (POI) after spine surgery depends on the surgical approach and definition used. It is therefore possible that the overall incidence is substantially higher than previously thought. POI has consequences for both the patient and hospital resources, and can significantly increase health care costs.MethodsWe retrospectively reviewed all patients aged 18 years or older who underwent elective complex spine surgery at our tertiary referral institution from 2011 through 2017. Preoperative comorbidities, operating time and approach, estimated blood loss, postoperative complications, and length of stay (LOS) were analyzed for patients meeting the inclusion criteria.ResultsOf 174 patients included in the study, 32 patients (18.4%) developed POI, leading to a significant increase in their median LOS (9 vs. 7 days; P = 0.020). Total estimated blood loss (1649.5 ± 1266.2 vs. 1124.6 ± 936.3 mL; P = 0.009) and total surgical time (501.6 ± 170.5 vs. 388.4 ± 159.8 minutes; P < 0.001) were significantly higher in the POI cohort. The use of nonselective μ-opioid receptor antagonists in 66% of patients with POI did not significantly impact the median LOS (9 vs. 8 days; P = 0.477) compared with patients with POI who did not receive this intervention. The incidence of postoperative adverse events other than ileus was similar between the 2 patient groups.ConclusionsDespite use of early interventions, the median LOS remains significantly longer in patients who develop POI after complex spine surgery. Knowledge of the associated predictive risk factors could potentially assist with the development of rigorous, evidence-based preventative strategies.Copyright © 2019 Elsevier Inc. All rights reserved.

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