Postoperative Ileus: Old and New Observations on Prevention and Treatment in Adult Spinal Deformity Surgery

Anna K. Wright, Danielle La Selva, Louis Nkrumah, Vijay Yanamadala, Jean Christophe Leveque, Rajiv K. Sethi

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: The 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. Methods: We 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. Results: Of 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. Conclusions: Despite 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.

Original languageEnglish (US)
Pages (from-to)e618-e622
JournalWorld Neurosurgery
StatePublished - Dec 2019


  • Adult spinal deformity (ASD) surgery
  • Length of stay (LOS)
  • Postoperative ileus (POI)
  • Surgical complications

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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