Postoperative Ileus and Gastrointestinal Complications following Spine Surgery: A Systematic Review of Incidence, Risk Factors, Prevention, and Treatment

Introduction: Post-operative Ileus (POI) and other gastrointestinal (GI) complications comprise a significant portion of medical complications seen in spine surgery patients. In addition to being a barrier to effective pain management and recovery, these complications lead to longer lengths of stay, higher costs, and more readmission and reoperations. The goal of this paper is to provide a comprehensive analysis of all aspects of care including incidence, risk factors, prevention and treatment recommendations of ileus and GI complications in spine patients.

Methods: A systematic review of the literature through June 2024 was performed according to PRISMA guidelines. Inclusion criteria included original studies reporting on aspects of POI and GI complications following adult spine surgery including incidence, risk factors, prevention and treatment recommendations.

Results: Of the initial 845 records identified from PubMed, 57 primary articles were determined to meet all the inclusion criteria and were used for data analysis. 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 ( < 1%). Male sex, increased levels fused, and lumbar level were the only unanimous risk factors with other potential variables including older age, liver disease, electrolyte imbalances, and anterior approach. Increased surgical time, certain intraoperative opioids (remifentanil, sufentanil), and increased opiate dosages are risk factors. In addition to restricting early oral intake, early mobilization and chewing gum are simple prevention strategies. No prophylactic medications were successful in preventing POI in spine surgery patients. Symptoms typically resolve with conservative management including NPO, IV 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.

Conclusion : The incidence of postoperative ileus after spinal surgery is high. Common risk factors for POI were male sex, increased surgical time, increased opioid used intraoperatively, and increased number of levels fused, and surgery on the lumbar spine. Early ambulation for prevention and early recognition for treatment is important.