Incidence and Risk Factors of Gastrointestinal and Hepatobiliary Complications after Spinal Fusion Surgery: a Retrospective Cohort Study

Abstract

Background: Spinal surgery holds a higher chance of unpredicted postoperative medical complications among orthopedic surgeries. Several studies have analyzed the risk factors for diverse postoperative medical complications, but the majority investigated incidences of each complication qualitatively. Among gastrointestinal complications, reports regarding postoperative ileus were relatively frequent. However, risk factors or incidences of hepatobiliary complications have yet to be investigated. The purpose of this study was to examine the incidence of gastrointestinal complications after spinal surgery, quantitatively analyze the risk factors of frequent complications, and to determine cues requiring early approaches. Methods: In total, 234 consecutive patients who underwent spinal fusion surgery performed by one senior doctor at our institute in one-year period were retrospectively enrolled for analyses. The primary outcomes were presence of paralytic ileus, elevated serum alanine transaminase (ALT) and aspartate transaminase (AST) levels, and elevated total bilirubin levels. Univariate logistic regression analyses of all variables were performed. In turn, significant results were reanalyzed by multivariate logistic regression. The variables used were adjusted with age and gender. Results: Gastrointestinal complications were observed in 15.8% of patients. Upon the risk factors of postoperative ileus, duration of anesthesia (odds ratio [OR], 1.373; P = 0.015), number of fused segments (OR, 1.202; P = 0.047), and hepatobiliary diseases (OR, 2.976; P = 0.029) were significantly different. For elevated liver enzymes, men (OR, 2.717; P = 0.003), number of fused segments (OR, 1.234; P = 0.033), and underlying hepatobiliary (OR, 2.704; P = 0.031) and rheumatoid diseases (OR, 5.021; P = 0.012) had significantly different results. Lastly, risk factors for total bilirubin elevation were: duration of anesthesia (OR, 1.431; P = 0.008), number of fused segments (OR, 1.359; P = 0.001), underlying hepatobiliary diseases (OR, 3.426; P = 0.014), and thoracolumbar junction involving fusions (OR, 4.134; P = 0.002) compared to lumbar spine limited fusions. Conclusion: Patients on postoperative care after spinal surgery should receive direct attention as soon as possible after manifesting abdominal symptoms. Laboratory and radiologic results must be carefully reviewed, and early consultation to gastroenterologists or general surgeons is recommended to avoid preventable complications.

Validity of the I‑FEED classification in assessing postoperative gastrointestinal impairment in patients undergoing elective lumbar spinal surgery with general anesthesia: a prospective observational study

“…Furthermore, we observed a high incidence of postoperative abdominal distension (approximately 86%) in this study. This is compatible with the recently reported rate of abdominal pain (71%) after lumbar spine surgery in a Korean cohort (Bahk et al 2020 ). However, this symptom does not necessarily increase the clinical burden, but the I-FEED classification may be helpful for clinicians to detect clinically relevant risk stratification.…”

“…The incidence of postoperative ileus after lumbar spine surgery was reported to be between 3 and 15% in the retrospective literature (Jaber et al 2021 ; Fineberg et al 2014 ; Bahk et al 2020 ; Kiely et al 2016 ). However, we observed a higher incidence of POGD (approximately 25%).…”

“…Several risk factors for postoperative ileus were reported in previous retrospective reports, including higher surgical complexity (spine surgical invasiveness), higher blood loss (Fineberg et al 2014;Bahk et al 2020), higher iv fluid amount (Fineberg et al 2014;Kiely et al 2016), and higher opioid consumption (Gifford et al 2019). Intraoperative spinal manipulations over upper lumbar levels may damage splanchnic nerves, resulting in decreased GI motility, and hence, higher spine surgical invasiveness may be harmful to postoperative GI motility (Boos and Aebi 2008).…”

“…Postoperative ileus is a recognized complication after lumbar spine surgery and is associated with worse postoperative outcomes (Jaber et al 2021 ; Fineberg et al 2014 ). The incidence of ileus after lumbar spine surgery has been reported across a wide range, between 2 and 33%, in the literature (Fineberg et al 2014 ; Bahk et al 2020 ; Kiely et al 2016 ; Lee et al 2015 ; Oh et al 2015 ). This huge discrepancy in the reported incidence may stem from ambiguous definitions of postoperative ileus between different studies.…”