Objective:

Postoperative ileus (POI) is a known complication following spine surgery. This study comprehensively reviews the existing literature and evaluates the risk factors associated with POI following thoracolumbar and lumbar fusion surgeries.

Methods:

In accordance with PRISMA guidelines, a comprehensive search was conducted for articles on ileus following the surgical treatment of spinal pathologies. Variables including gender, age, BMI, comorbidities, approach, type of surgery performed, levels fused, anesthesia time, and length of stay were considered as the main outcomes of measurement. Meta-analyses were conducted using random models according to the between-study heterogeneity, estimated with I². Sensitivity analysis was performed with heterogeneity greater than 50%.

Results:

Ten articles compromising a total of 297,809 patients met the inclusion criteria. POI following lumbar surgery had a statistically significant association with increased age, surgical time, anesthesia time, estimated blood loss (EBL), and length of stay. The pooled mean differences were 1.70 years (95% confidence interval [CI]: 1.52 to 1.87, p<0.0001), 83.02 minutes (CI: 41.20 to 124.84, p=0.0001), 64.97 minutes (CI: 31.43 to 98.50, p=0.0001), 439.04 cc (CI: 250.60 to 627.49, p<0.001), and 2.97 days (CI: 2.54 to 3.40, P<0.001), respectively. Furthermore, individuals undergoing spinal fusion had higher odds of POI if they were male (odds ratio [OR] 1.33; CI: 1.06 to 1.67, p=0.01), if an anterior approach was performed (OR: 1.97; CI: 1.29 to 3.01; P=0.002), or if >3 vertebral levels were fused (OR: 3.99; CI: 1.28 to 12.44; P=0.02). Body mass index did not show any association with POI.

Conclusions:

Risk factors associated with POI following spinal fusion surgery include male gender, older age, longer surgical times, higher EBL, longer lengths of stay, greater numbers of levels of fusion, and anterior surgical approach.