Original ArticlesPostoperative ileus in the lower extremity arthroplasty patient*,**
Section snippets
Materials and methods
With a hospital-based computer information system, we used ICD-9 codes to identify 21,589 patients that were treated with either THA or TKA between January 1988 and December 1997 at our institution. Using the same method, we identified all the patients in whom postoperative ileus developed after TJA; 70 such cases were identified. The medical records of each of the 70 patients were analyzed. All the cases were diagnosed by the absence of bowel sounds, the absence of flatus, and radiographic
Results
All THAs and TKAs were performed by 18 orthopaedic surgeons at our institution. Most of these cases (64.4%) were performed by only 4 surgeons. Of the 70 patients with ileus, 1 patient was given general anesthesia with endotracheal intubation. All other patients were given regional anesthesia. Lumbar epidurals were administered in a standard method using either 0.75% bupivacaine or 2% lidocaine with epinephrine.
Type I ileus developed in 38 patients (54%), and type II ileus developed in 32
Discussion
Postoperative ileus causes significant morbidity and mortality in TJA patients. In this series of 21,589 patients who underwent such surgery from 1988 to 1997, 70 cases of postoperative ileus represented an overall incidence of 0.3%. Risk factors for the development of type II ileus have been related to method of anesthesia [4], postoperative narcotics 5, 6, previous abdominal surgery, and early feeding [7]. In the present series, postoperative narcotics were not statistically significantly
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2022, Journal of ArthroplastyModifiable Analgesia-/Anesthesia-Related Factors and Risk of Severe Gastrointestinal Complications After Lower Extremity Total Joint Arthroplasty: A Nationwide Analysis
2020, Journal of ArthroplastyCitation Excerpt :This trend might be related to implementation of specific improved patient care and/or implementation of specific Enhanced Recovery After Surgery pathways. These perioperative regimens put emphasis on early mobilization, short-acting regional anesthesia, and multimodal pain management [1,15,16]. Subsequently, a reduced opioid prescription might have positive impact on bowel motility in the early postoperative period [2].
Comparison Study of Patient Demographics, Risk Factors, and Lengths of Stay for Postoperative Ileus After Primary Total Knee Arthroplasty
2020, Journal of ArthroplastyCitation Excerpt :They found that 0.7% of patients (31 of 4567) developed postoperative ileus within 2.5 days after TJA with older patients (P = .035) and male gender (P < .005) being at significant risk. Similarly, Bederman et al [1] analyzed risk factors for postoperative ileus in 21,589 patients undergoing primary TJA from 1988 to 1997 and found male gender (OR, 4.8; P < .02) and patients undergoing bilateral knee surgery (P = .001) to be risk factors. We found that patients with higher BMI levels and electrolyte derangements were risk factors for postoperative ileus.
Perioperative considerations of bilateral total knee replacement: A review
2013, Journal of Clinical AnesthesiaCitation Excerpt :Gradillas and Volz [71] reported a 4-fold increase in superficial wound problems in the bilateral group but no increase in postoperative wound infections, compared with the unilateral group. Bederman et al [72] noted a statistically significant difference in the rate of postoperative ileus between UTKR (0.23%) and BTKR (0.87%). This complication was more common among male patients and younger patients.
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No benefits or funds were received in support of this study.
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Reprint requests: Thomas P. Sculco, MD, 535 East 70th Street, New York, NY 10021. E-mail: [email protected]