Mandl Lisa A, Sasaki Mayu, Yang Jingyan, Choi Sara, Cummings Kelianne, Goodman Susan M
Department of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA.
Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA.
HSS J. 2020 Dec;16(Suppl 2):272-279. doi: 10.1007/s11420-019-09712-z. Epub 2019 Aug 16.
Post-operative ileus (POI) is common and can be associated with significant morbidity.
QUESTIONS/PURPOSES: We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery.
We conducted a retrospective case-control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI.
Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI.
In this retrospective case-control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.
术后肠梗阻（POI）很常见，且可能伴有严重的发病率。
问题/目的：我们旨在确定择期骨科手术后严重术后肠梗阻（SPOI）的发生率及相关危险因素。
我们在一家单一的肌肉骨骼专科医院对接受择期骨科手术的患者进行了一项回顾性病例对照研究。SPOI病例与非POI对照按1:2匹配。使用国际疾病分类第九版（ICD-9）编码来识别被编码为患有POI发作的患者。在查阅病历后，根据既定标准将一部分患者分类为临床SPOI病例。构建回归模型以识别与SPOI相关的变量。
在273例POI病例中，77例（28.2%）被分类为SPOI。SPOI的总体发生率为2.74/1000例骨科出院患者，SPOI在脊柱手术中最常见（9.07/1000例脊柱手术出院患者）。产生假设的多变量条件逻辑回归表明，对于髋关节和膝关节病例，术后第2天（POD）未恢复正常饮食会增加SPOI的风险。对于脊柱病例，术后第2天未恢复正常饮食和手术时间较长与SPOI风险相关。
在这项回顾性病例对照研究中，术后第2天未恢复正常饮食的择期骨科手术患者以及手术时间较长的脊柱患者发生SPOI的风险最高。围手术期医生可在临床上利用这些数据根据风险对患者进行分层。
