Al Maaieh Motasem A, Du Jerry Y, Aichmair Alexander, Huang Russel C, Hughes Alexander P, Cammisa Frank P, Girardi Federico P, Sama Andrew A
From the Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, New York City, NY.
Spine (Phila Pa 1976). 2014 Apr 15;39(8):688-94. doi: 10.1097/BRS.0000000000000238.
Retrospective cohort study.
To assess for independent risk factors of postoperative ileus (POI) after lateral lumbar interbody fusion (LLIF).
POI is frequently observed in anterior lumbar interbody fusion due to significant bowel manipulation during the approach. LLIF is a minimally invasive approach to the anterior column with reduced bowel manipulation and surgical time. However, there is a paucity of literature on POI after LLIF.
A retrospective review was performed of records of patients who underwent LLIF from January 2006 to December 2011 at a single institution. Patients with prolonged and recurrent POI were identified by review of hospital stay documentation by a fellowship-trained spine surgeon and a research fellow. POI patients were matched 1:1 to a control cohort without POI. Uni- and multivariate analyses were performed on demographic, comorbidity, surgical indication, medication, and perioperative details to identify independent risk factors for POI.
Incidence of prolonged or recurrent POI after LLIF was 7.0% (42/596). Postoperative length of stay was significantly higher for patients with POI (9.9 ± 4.3 d) than control patients (5.6 ± 4.1 d) (P < 0.001). The incidence of ileus in the first 100 LLIF cases (11%) was not significantly higher than in the last 100 LLIF cases (6%) (P = 0.21). Independent risk factors were history of gastroesophageal reflux disease (P < 0.01, adjusted odds ratio [aOR]: 24.31), posterior instrumentation (P = 0.002, aOR: 19.48), and LLIF at L1-L2 (P = 0.04, aOR: 7.82). A history of prior abdominal surgery approached significance as an independent protective factor (P = 0.07, aOR: 0.29).
There was a relatively high incidence of POI after LLIF. Independent risk factors for POI were a history of gastroesophageal reflux disease, posterior instrumentation, and LLIF at L1-L2. A history of prior abdominal surgery approached significance as an independent protective factor.
回顾性队列研究。
评估腰椎侧方椎间融合术（LLIF）后术后肠梗阻（POI）的独立危险因素。
由于前路手术过程中对肠道的显著操作，POI在前路腰椎椎间融合术中经常被观察到。LLIF是一种对前柱的微创方法，减少了肠道操作和手术时间。然而，关于LLIF后POI的文献较少。
对2006年1月至2011年12月在单一机构接受LLIF的患者记录进行回顾性分析。由一名接受过脊柱外科专科培训的外科医生和一名研究员通过查阅住院记录，确定POI持续时间延长和复发的患者。将POI患者与无POI的对照队列按1:1匹配。对人口统计学、合并症、手术指征、用药情况和围手术期细节进行单因素和多因素分析，以确定POI的独立危险因素。
LLIF后POI持续时间延长或复发的发生率为7.0%（42/596）。POI患者的术后住院时间（9.9±4.3天）显著高于对照患者（5.6±4.1天）（P<0.001）。前100例LLIF病例中的肠梗阻发生率（11%）并不显著高于后100例LLIF病例（6%）（P = 0.21）。独立危险因素为胃食管反流病病史（P<0.01，调整优势比[aOR]：24.31）、后路内固定（P = 0.002，aOR：19.48）以及L1-L2节段的LLIF（P = 0.04，aOR：7.82）。既往腹部手术史作为独立保护因素接近显著水平（P = 0.07，aOR：0.29）。
LLIF后POI的发生率相对较高。POI的独立危险因素为胃食管反流病病史、后路内固定以及L1-L2节段的LLIF。既往腹部手术史作为独立保护因素接近显著水平。
3级。
