Risk Factors, Additional Length of Stay, and Cost Associated with Postoperative Ileus Following Anterior Lumbar Interbody Fusion in Elderly Patients

Objective: To identify independent risk factors, additional length of stay, and additional cost associated with postoperative ileus following anterior lumbar interbody fusion in elderly patients.

Methods: The PearlDiver Patient Records Database was queried for all Medicare patients ≥65 years of age 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.

Results: There were 13,139 patients identified, and 642 patients experienced postoperative ileus within 3 days after surgery. Multivariate analysis identified perioperative fluid or electrolyte imbalance (odds ratio = 4.03; 95% confidence interval, 3.37-4.80; P < 0.001) and male sex (odds ratio = 1.72; 95% confidence interval, 1.48-2.00; P < 0.001) as independent risk factors for ileus. Multivariate analysis associated postoperative ileus with additional length of stay of 2.83 ± 0.11 days (P < 0.001) and additional cost of $2,349 ± $419 (P < 0.001).

Conclusions: Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolyte levels 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.