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The Journal of Hip Surgery 2022; 06(02): 063-068
DOI: 10.1055/s-0042-1744134
Original Article

Risk Factors for Postoperative Ileus following Primary Total Hip Arthroplasty

Nicoletta A. Kijak
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Mitchell K. Ng
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Charles A. Conway
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Rushabh M. Vakharia 
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Afshin E. Razi
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Che Hang Jason Wong
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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Abstract

Postoperative ileus (POI) is a feared complication following surgery. The purpose of this study was to (1) compare patient demographics between patients who developed and did not develop POI following primary total hip arthroplasty (THA), (2) compare in-hospital lengths of stay (LOS), and (3) identify patient-related risk factors associated with developing POI after primary THA. Using the 100% Medicare Standard Analytical Files from the PearlDiver from 2005 to 2014, patients developing POI within 3 days following primary THA were identified as the study cohort, whereas patients not developing POI served as the comparison cohort. Primary endpoints of the study included comparing patient demographics, in-hospital LOS, and identifying patient-related risk factors. A multivariate binomial logistic regression analysis was used to identify patient-related risk factors by calculating odds ratio (OR) for the risk of developing POI. A p-value less than 0.001 was considered to be statistically significant. The query yielded 335 patients (0.03%) who developed POI following their primary THA procedure. The study group was significantly different compared with controls with respect to age (p < 0.0001), sex (p < 0.0001), and prevalence of comorbid conditions. Patients who developed POI had longer in-hospital LOS (5 vs. 3 days, p < 0.0001). Risk factors associated with POI included electrolyte and fluid imbalance (OR: 3.06, p < 0.0001), male sex (OR: 2.86, p < 0.0001), and obesity (OR: 1.89, p < 0.0001). The study found significant differences among patients who did and did not develop POI following primary THA and several associated risk factors for the complication. Identification and adequate preoperative optimization of modifiable risk factors could potentially reduce the incidence of POI.

Keywords

total hip arthroplasty - postoperative ileus - Medicare - risk factors


Publication History

Received: 12 August 2021

Accepted: 11 January 2022

Article published online:
09 March 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Livingston EH, Passaro Jr EP. Postoperative ileus. Dig Dis Sci 1990; 35 (01) 121-132
    CrossrefPubMedGoogle Scholar
  • 2 Venara A, Neunlist M, Slim K. et al. Postoperative ileus: pathophysiology, incidence, and prevention. J Visc Surg 2016; 153 (06) 439-446
    CrossrefPubMedGoogle Scholar
  • 3 Hain E, Maggiori L, Mongin C, Prost A la Denise J, Panis Y. Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients. Surg Endosc 2018; 32 (01) 337-344
    CrossrefPubMedGoogle Scholar
  • 4 Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F. Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 2004; (421) 155-161
    CrossrefPubMedGoogle Scholar
  • 5 Nelson JD, Urban JA, Salsbury TL, Lowry JK, Garvin KL. Acute colonic pseudo-obstruction (Ogilvie syndrome) after arthroplasty in the lower extremity. J Bone Joint Surg Am 2006; 88 (03) 604-610
    CrossrefPubMedGoogle Scholar
  • 6 Berend KR, Lombardi Jr AV, Mallory TH, Dodds KL, Adams JB. Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism. J Arthroplasty 2004; 19 (07, Suppl 2): 82-86
    CrossrefPubMedGoogle Scholar
  • 7 Fineberg SJ, Nandyala SV, Kurd MF. et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J 2014; 14 (08) 1680-1685
    CrossrefPubMedGoogle Scholar
  • 8 Parvizi J, Han S-B, Tarity TD, Pulido L, Weinstein M, Rothman RH. Postoperative ileus after total joint arthroplasty. J Arthroplasty 2008; 23 (03) 360-365
    CrossrefPubMedGoogle Scholar
  • 9 Bederman SS, Betsy M, Winiarsky R, Seldes RM, Sharrock NE, Sculco TP. Postoperative ileus in the lower extremity arthroplasty patient. J Arthroplasty 2001; 16 (08) 1066-1070
    CrossrefPubMedGoogle Scholar
  • 10 Klasan A, Amic F, Dworschak P, Madzarac G, Heyse TJ, Neri T. Risk factors for ileus after hip and knee arthroplasty. Int J Colorectal Dis 2019; 34 (02) 261-267
    CrossrefPubMedGoogle Scholar
  • 11 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (07) 1487-1497
    PubMedGoogle Scholar
  • 12 Donnally III CJ, Vakharia RM, Rush III AJ. et al. Fibromyalgia as a predictor of increased postoperative complications, readmission rates, and hospital costs in patients undergoing posterior lumbar spine fusion. Spine 2019; 44 (04) E233-E238
    CrossrefPubMedGoogle Scholar
  • 13 Sabeh KG, Rosas S, Buller LT, Freiberg AA, Emory CL, Roche MW. The impact of medical comorbidities on primary total knee arthroplasty reimbursements. J Knee Surg 2019; 32 (06) 475-482
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Buller LT, Rosas S, Sabeh KG, Roche MW, McLawhorn AS, Barsoum WK. Hypothyroidism increases 90-day complications and costs following primary total knee arthroplasty. J Arthroplasty 2018; 33 (04) 1003-1007
    CrossrefPubMedGoogle Scholar
  • 15 Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 2014; 472 (09) 2878-2886
    CrossrefPubMedGoogle Scholar
  • 16 Lakomkin N, Kothari P, Dodd AC. et al. Higher Charlson Comorbidity Index scores are associated with increased hospital length of stay after lower extremity orthopaedic trauma. J Orthop Trauma 2017; 31 (01) 21-26
    Google Scholar
  • 17 Camp CL, Tebo CC, Degen RM, Dines JS, Altchek DW, Werner BC. Patient-related risk factors for infection following ulnar nerve release at the cubital tunnel: an analysis of 15,188 cases. Orthop J Sports Med 2018; 6 (05) 2325967118772799
    CrossrefPubMedGoogle Scholar
  • 18 Cancienne JM, Patel KJ, Browne JA, Werner BC. Narcotic use and total knee arthroplasty. J Arthroplasty 2018; 33 (01) 113-118
    Google Scholar
  • 19 Werner BC, Teran VA, Deal DN. Patient-related risk factors for infection following open carpal tunnel release: an analysis of over 450,000 Medicare patients. J Hand Surg Am 2018; 43 (03) 214-219
    CrossrefPubMedGoogle Scholar
  • 20 Burrus MT, Diduch DR, Werner BC. Patient-related risk factors for postoperative stiffness requiring surgical intervention after arthroscopic rotator cuff repair. J Am Acad Orthop Surg 2019; 27 (07) e319-e323
    CrossrefPubMedGoogle Scholar
  • 21 Althoff A, Cancienne JM, Cooper MT, Werner BC. Patient-related risk factors for periprosthetic ankle joint infection: an analysis of 6977 total ankle arthroplasties. J Foot Ankle Surg 2018; 57 (02) 269-272
    CrossrefPubMedGoogle Scholar
  • 22 Cancienne JM, Brockmeier SF, Carson EW, Werner BC. Risk factors for infection after shoulder arthroscopy in a large Medicare population. Am J Sports Med 2018; 46 (04) 809-814
    CrossrefPubMedGoogle Scholar
  • 23 Cancienne JM, Dempsey IJ, Holzgrefe RE, Brockmeier SF, Werner BC. Is hepatitis C infection associated with a higher risk of complications after total shoulder arthroplasty?. Clin Orthop Relat Res 2016; 474 (12) 2664-2669
    CrossrefPubMedGoogle Scholar
  • 24 Wang K, Zhang N, Deng D, Qiu Y, Lin Y, Jin S. [Clinical analysis of perioperative electrolyte imbalance in 999 patients undergoing gastrointestinal surgery]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21 (12) 1427-1432
    PubMedGoogle Scholar
  • 25 Pikarsky AJ, Saida Y, Yamaguchi T. et al. Is obesity a high-risk factor for laparoscopic colorectal surgery?. Surg Endosc 2002; 16 (05) 855-858
    CrossrefPubMedGoogle Scholar
  • 26 Svatek RS, Fisher MB, Williams MB. et al. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology 2010; 76 (06) 1419-1424
    CrossrefPubMedGoogle Scholar
  • 27 Parker AS, Lewis R, Heckman MG. et al. Evaluation of the impact of body mass index on outcome among renal mass patients treated with hand-assisted laparoscopic radical nephrectomy. J Endourol 2008; 22 (02) 301-306
    CrossrefPubMedGoogle Scholar
  • 28 Liu Q, Jiang H, Xu D, Jin J. Effect of gum chewing on ameliorating ileus following colorectal surgery: a meta-analysis of 18 randomized controlled trials. Int J Surg 2017; 47: 107-115
    CrossrefPubMedGoogle Scholar
  • 29 Topcu SY, Oztekin SD. Effect of gum chewing on reducing postoperative ileus and recovery after colorectal surgery: a randomised controlled trial. Complement Ther Clin Pract 2016; 23: 21-25
    CrossrefPubMedGoogle Scholar
  • 30 Linari LR, Schofield LC, Horrom KA. Implementing a bowel program: is a bowel program an effective way of preventing constipation and ileus following elective hip and knee arthroplasty surgery?. Orthop Nurs 2011; 30 (05) 317-321
    CrossrefPubMedGoogle Scholar
  • 31 Nguyen BH, Bono OJ, Bono JV. Decreasing incidence of postoperative ileus following total knee arthroplasty: a 17-year retrospective review of 38,007 knee replacements at one institution. J Knee Surg 2020; 33 (08) 750-753
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Burrus MT, Werner BC, Cancienne JM, Gwathmey FW, Brockmeier SF. Shoulder arthroplasty in patients with Parkinson's disease is associated with increased complications. J Shoulder Elbow Surg 2015; 24 (12) 1881-1887
    CrossrefPubMedGoogle Scholar