Abstract
The incidence of lumbar fusion surgery for the treatment of degenerative conditions is increasing rapidly in the elderly population. In appropriately selected patients with symptomatic lumbar degenerative disease, lumbar interbody fusion has been shown to provide substantial improvement, regardless of the specific technique chosen. The anterior approach affords a number of benefits, but has been associated with a 2-3times higher incidence of postoperative ileus compared to the transforaminal or posterior approaches.
The purpose of this study was to identify the independent risk factors, additional length of stay, and additional cost associated with postoperative ileus following anterior lumbar interbody fusion in the elderly.
Retrospective analysis of Medicare insurance database.
Elderly patients with Medicare insurance treated between 2005 and 2014.
The primary outcome measure studied was the incidence of postoperative ileus. Secondary outcome measures included average hospitalization cost and length of stay.
Records of patients with Medicare insurance were retrospectively reviewed to identify patients 65years of age and older undergoing 1 or 2 level primary elective anterior lumbar interbody fusion from 2005 to 2014. Independent risk factors, additional length of stay and additional cost associated with postoperative ileus were evaluated with multivariate analysis.
A total of 13,139 patients were identified. Of the identified patients, 642 experienced postoperative ileus within 3days of surgery. Multivariate analysis identified fluid and electrolyte imbalance within 3days of surgery (odds ratio=4.03, P<.001) and male sex (odds ratio=1.72, P<.001) as independent risk factors for ileus. Multivariate analysis also associated postoperative ileus with additional length of stay of 2.83 days±0.11days (P <.001) and additional cost of $2,349±$419 (P<.001).
Patients with perioperative fluid and electrolyte imbalances were 4times as likely to experience postoperative ileus. Fluid balance and electrolytes should be carefully monitored during the perioperative period in patients undergoing anterior lumbar interbody fusion as a potential means to reduce the incidence of postoperative ileus and the additional length of stay and cost burden associated with this complication.