Elsevier

The Journal of Arthroplasty

Volume 16, Issue 8, December 2001, Pages 1066-1070
The Journal of Arthroplasty

Original Articles
Postoperative ileus in the lower extremity arthroplasty patient*,**

https://doi.org/10.1054/arth.2001.27675Get rights and content

Abstract

Postoperative ileus is a recognized complication of lower extremity surgery. In a review of 21,589 patients who underwent either total hip or total knee arthroplasty between 1988 and 1997, 0.32% developed postoperative ileus. The ileus lasted >3 days in 46% of patients. The purpose of this study was to investigate the risk factors associated with ileus during 3 days after total joint arthroplasty. The average age of the patients with prolonged ileus was 69.1 years, and 70% were male. The development of a prolonged ileus was associated significantly with younger age (P<.005) and male gender (P<.02). In total knee arthroplasty, more cases of postoperative ileus were seen in bilateral surgery. Patients who are younger, male, and undergoing bilateral total knee arthroplasty are at an increased risk of having a more prolonged postoperative ileus and should be monitored closely.

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

References (19)

  • R Iorio et al.

    The association of excessive warfarin anticoagulation and postoperative ileus after total joint replacement surgery

    J Arthroplasty

    (2000)
  • RS Wojtalik et al.

    Perforation the colon associated with adynamic ileus

    Am J Surg

    (1973)
  • J Smith et al.

    Pathophysiology of postoperative ileus

    Arch Surg

    (1977)
  • EH Livingston et al.

    Postoperative ileus

    Dig Dis Sci

    (1990)
  • J Fischer et al.

    Manifestations of gastrointestinal disease

  • RA Steinbrook

    Epidural anesthesia and gastrointestinal motility

    Anesth Analg

    (1998)
  • H Yukioka et al.

    Recovery of bowel motility after surgery: detection of time of first flatus from carbon dioxide concentration and patient estimate after nalbuphine and placebo

    Br J Anaesth

    (1987)
  • JA LaRosa et al.

    The incidence of adynamic ileus in postcesarean patients: patient-controlled analgesia versus intramuscular analgesia

    J Reprod Med

    (1993)
  • NS Eftekhar

    Part IX. Postoperative complications

There are more references available in the full text version of this article.

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  • Modifiable Analgesia-/Anesthesia-Related Factors and Risk of Severe Gastrointestinal Complications After Lower Extremity Total Joint Arthroplasty: A Nationwide Analysis

    2020, Journal of Arthroplasty
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    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 Arthroplasty
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    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 Anesthesia
    Citation 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.

**

Reprint requests: Thomas P. Sculco, MD, 535 East 70th Street, New York, NY 10021. E-mail: [email protected]

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