Postoperative ileus and gastrointestinal complications following spine surgery: A systematic review of incidence, risk factors, prevention, and treatment.

Postoperative Ileus (POI) and other gastrointestinal (GI) complications comprise a significant portion of medical complications seen in spine surgery patients. Experts hypothesize that ileus can occur due to a combination of anesthetic agents, opioid-induced intestinal dysmotility, and decreased mobility. POI and GI complications lead to longer lengths of stay, increased hospital costs, and increased risk of readmission and reoperation in spine surgery patients. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 59 primary articles met the inclusion criteria. The reported incidence of POI following spine surgery varied significantly from 0.2% to 35.4%, with the middle 50% of studies ranging from 5.1% to 13.6%. Cumulative GI complication rates ranged from 2.1% to 16.2%, with more severe pathologies such as acute colonic pseudo-obstruction (ACPO) having expectedly low incidences of <1%. Conclusions regarding potential risk factors were highly variable. Male sex, increased levels fused, and lumbar level fusions were the only unanimous variables. Intraoperatively, increased surgical time, certain intraoperative opioids (remifentanil, sufentanil), and increased opiate dosages are associated with increased rates of ileus. Early feeding as a prevention strategy has demonstrated variable efficacy, while early mobilization and gum-chewing have been shown to stimulate bowel function. If ileus does occur, symptoms typically resolve with conservative management including NPO, intravenous fluid maintenance, electrolyte replacement, laxatives, and adding nasogastric suctioning when bloating and nausea are more severe. If patients fail conservative treatment, physicians can add promotility agents such as neostigmine. The incidence of POI after spinal surgery is high. Identification and appropriate mitigation of risk factors, as well as early ambulation for prevention and early recognition for treatment are important in the event of ileus.