Decreasing Incidence of Postoperative Ileus following Total Knee Arthroplasty: A 17-Year Retrospective Review of 38,007 Knee Replacements at One Institution

Abstract

Ileus following total knee arthroplasty is a clinically and financially significant postoperative complication that has not been extensively described in the orthopaedic joint literature. Ileus has been found to occur in 0.7 to 4.0% of patients after total joint arthroplasty. In a 17-year period (2001 fiscal year through 2017 fiscal year) at one institution, we found an incidence of 0.500% (190/38,007) following knee arthroplasty. In addition, the incidence of ileus following total knee arthroplasty (TKA) has drastically declined over this 17-year period, from 1.593% (13/816) in 2001 to 0.120% (4/3,332) in 2017. This decrease may be attributed to a reduction in narcotic use postoperatively, earlier ambulation following surgery, and reduction in length of hospital stay. Though postoperative ileus is not yet a preventable complication, recognition of risk factors may permit earlier intervention to ameliorate some of the morbidity associated with this condition.

Keywords

ileus - postoperative ileus - total knee arthroplasty - orthopaedic surgical complications

• References

• 1 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
• 2 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
• 3 Parvizi J, Han SB, Tarity TD, Pulido L, Weinstein M, Rothman RH. Postoperative ileus after total joint arthroplasty. J Arthroplasty 2008; 23 (03) 360-365
• 4 Camer S. Surgical Complications in Revision Arthroplasty. In: Bono JV, McCarthy JC, Thornhill ThS, Bierbaum BE, Turner RH. , eds. Revision Total Hip Arthroplasty. New York: Springer-Verlag; 1999: 438-447
• 5 Livingston EH, Passaro Jr EP. Postoperative ileus. Dig Dis Sci 1990; 35 (01) 121-132
• 6 Luckey A, Livingston E, Taché Y. Mechanisms and treatment of postoperative ileus. Arch Surg 2003; 138 (02) 206-214
• 7 Szurszewski JH. A migrating electric complex of canine small intestine. Am J Physiol 1969; 217 (06) 1757-1763
• 8 De Winter BY, Boeckxstaens GE, De Man JG, Moreels TG, Herman AG, Pelckmans PA. Effect of adrenergic and nitrergic blockade on experimental ileus in rats. Br J Pharmacol 1997; 120 (03) 464-468
• 9 Bayliss WM, Starling EH. The movements and innervation of the small intestine. J Physiol 1899; 24 (02) 99-143
• 10 Deloof S, Croix D, Tramu G. The role of vasoactive intestinal polypeptide in the inhibition of antral and pyloric electrical activity in rabbits. J Auton Nerv Syst 1988; 22 (02) 167-173
• 11 Freeman ME, Cheng G, Hocking MP. Role of alpha- and beta-calcitonin gene-related peptide in postoperative small bowel ileus. J Gastrointest Surg 1999; 3 (01) 39-43
• 12 Kalff JC, Schraut WH, Billiar TR, Simmons RL, Bauer AJ. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 2000; 118 (02) 316-327
• 13 Ogilvy AJ, Smith G. The gastrointestinal tract after anaesthesia. Eur J Anaesthesiol Suppl 1995; 10: 35-42
• 14 Steinbrook RA. Epidural anesthesia and gastrointestinal motility. Anesth Analg 1998; 86 (04) 837-844
• 15 Bisgaard C, Mouridsen P, Dahl JB. Continuous lumbar epidural bupivacaine plus morphine versus epidural morphine after major abdominal surgery. Eur J Anaesthesiol 1990; 7: 219-225
• 16 Jørgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery. Br J Anaesth 2001; 87 (05) 727-732
• 17 Neudecker J, Schwenk W, Junghans T, Pietsch S, Böhm B, Müller JM. Randomized controlled trial to examine the influence of thoracic epidural analgesia on postoperative ileus after laparoscopic sigmoid resection. Br J Surg 1999; 86 (10) 1292-1295
• 18 Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acta Anaesthesiol Scand 1987; 31 (02) 161-164
• 19 Thorén T, Sundberg A, Wattwil M, Garvill JE, Jürgensen U. Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy. Acta Anaesthesiol Scand 1989; 33 (02) 181-185
• 20 Borody TJ, Quigley EM, Phillips SF. , et al. Effects of morphine and atropine on motility and transit in the human ileum. Gastroenterology 1985; 89 (03) 562-570
• 21 Reisine T, Pasternak G. Opioid analgesics and antagonists. In: Hardman JG, Limbird LE. , eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 9th ed. New York, NY: McGraw-Hill Co.; 1996
• 22 Foss JF. A review of the potential role of methylnaltrexone in opioid bowel dysfunction. Am J Surg 2001; 182 (5A, Suppl): 19S-26S
• 23 Taguchi A, Sharma N, Saleem RM. , et al. Selective postoperative inhibition of gastrointestinal opioid receptors. N Engl J Med 2001; 345 (13) 935-940
• 24 Cheatham ML, Chapman WC, Key SP, Sawyers JL. A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy. Ann Surg 1995; 221 (05) 469-476 , discussion 476–478
• 25 Sagar PM, Kruegener G, MacFie J. Nasogastric intubation and elective abdominal surgery. Br J Surg 1992; 79 (11) 1127-1131
• 26 Richter III HM, Kelly KA. Effect of transection and pacing on human jejunal pacesetter potentials. Gastroenterology 1986; 91 (06) 1380-1385
• 27 Heslin MJ, Latkany L, Leung D. , et al. A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Ann Surg 1997; 226 (04) 567-577 , discussion 577–580
• 28 Jepsen S, Klaerke A, Nielsen PH, Simonsen O. Negative effect of Metoclopramide in postoperative adynamic ileus. A prospective, randomized, double blind study. Br J Surg 1986; 73 (04) 290-291
• 29 Yee MK, Evans WD, Facey PE, Hayward MW, Rosen M. Gastric emptying and small bowel transit in male volunteers after i.m. ketorolac and morphine. Br J Anaesth 1991; 67 (04) 426-431
• 30 Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999; 73 (03) 412-414
• 31 Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002; 195 (01) 30-32
• 32 Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on gastrointestinal function after elective colon resection. Lancet 2002; 359 (9320): 1812-1818
• 33 Behm B, Stollman N. Postoperative ileus: etiologies and interventions. Clin Gastroenterol Hepatol 2003; 1 (02) 71-80
• 34 Waldhausen JH, Shaffrey ME, Skenderis II BS, Jones RS, Schirmer BD. Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 1990; 211 (06) 777-784 , discussion 785
• 35 Feldman RA, Karl RC. Diagnosis and treatment of Ogilvie's syndrome after lumbar spinal surgery. Report of three cases. J Neurosurg 1992; 76 (06) 1012-1016
• 36 Price SJ, Buxton N. Adynamic ileus complicating lumbar laminectomy: a report of two cases. Br J Neurosurg 1998; 12 (02) 162-164
• 37 Clarke HD, Berry DJ, Larson DR. Acute pseudo-obstruction of the colon as a postoperative complication of hip arthroplasty. J Bone Joint Surg Am 1997; 79 (11) 1642-1647
• 38 Goodrich A. Pseudo-obstruction of the colon. A postoperative complication in orthopaedic patients. J Bone Joint Surg Am 1983; 65 (06) 872