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J Neurol Surg B Skull Base 2025; 86(05): 547-555
DOI: 10.1055/s-0044-1791806
Original Article

Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Theodore V. Nguyen   *
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Ellen M. Hong   *
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Benjamin F. Bitner
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Michelle Chernyak
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Daniella Chan
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Katelyn K. Dilley
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Arash Abiri
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Ji Y. Li
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Sina J. Torabi
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Jonathan C. Pang 
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
,
Frank P.K. Hsu
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
2   Department of Neurological Surgery, University of California, Irvine, Orange, California, United States
,
Edward C. Kuan 
1   Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States
2   Department of Neurological Surgery, University of California, Irvine, Orange, California, United States
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Abstract

Objective

Postoperative constipation in endoscopic skull base surgery (ESBS) may provoke undesired straining, which, in theory, may create intracranial pressure shifts and impact skull base reconstruction. The purpose of this study is to assess the prevalence and contributing factors to postoperative constipation after ESBS, and whether this impacts reconstructive outcomes.

Methods

Patients undergoing ESBS between July 2018 and December 2022 at a single-center, tertiary academic skull base surgery program were retrospectively reviewed. Chart reviews were performed to identify average bowel movements per day, indication for surgery, age, sex, body mass index (BMI), history of chronic pain, length of postoperative bedrest, length of stay (LOS), and postoperative use of opioid analgesics. Additionally, use of a standing stool bowel regimen, as-needed (PRN) stool softeners/laxatives, and enemas were recorded. Constipation was defined as greater than 48 hours without a bowel movement.

Results

In total, 213 patients (115 with intradural pathologies) were identified, of which 146 (69%) patients had postoperative constipation. Postoperative constipation was associated with longer bedrest (1.86 ± 0.20 vs. 1.06 ± 0.12 days; p = 0.011); increased morphine equivalent dose (MED) during postoperative days 2, 3, 5, and 6 (all p < 0.05); and total postoperative MED (106.70 ± 14.01 vs. 46.88 ± 8.44 mg; p < 0.001). Additionally, postoperative constipation was an independent predictor of LOS (p = 0.009). There were no differences in postoperative cerebrospinal fluid (CSF) leak between the groups (p = 0.622).

Conclusion

Postoperative constipation rates were high after ESBS and likely causative factors include increased immobilization and postoperative opioid use. Standing bowel regimens should be considered in ESBS patients. However, there was no increased rate of postoperative CSF leaks.

Keywords

skull base reconstruction outcomes - postoperative - analgesia - opioid - constipation - CSF leak

Previous Presentation

This work was presented preliminarily as a poster at the Triological Society Combined Sections Meeting in Coronado, CA, January 26–28, 2023.


* These authors contributed equally to this work.




Publikationsverlauf

Eingereicht: 04. Januar 2024

Angenommen: 17. September 2024

Artikel online veröffentlicht:
23. Oktober 2024

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