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

Area of Science:

• Neurosurgery
• Gastroenterology
• Surgical Outcomes

Background:

• Postoperative constipation following endoscopic skull base surgery (ESBS) can lead to straining, potentially causing intracranial pressure shifts and impacting surgical reconstruction.
• Understanding the prevalence and contributing factors of constipation is crucial for optimizing patient recovery and reconstructive success.

Purpose of the Study:

• To determine the prevalence of postoperative constipation in patients undergoing ESBS.
• To identify factors contributing to constipation after ESBS.
• To assess the impact of postoperative constipation on reconstructive outcomes.

Main Methods:

• Retrospective review of 213 patients who underwent ESBS between July 2018 and December 2022.
• Data collected included bowel movement frequency, surgical indication, patient demographics, BMI, chronic pain history, bedrest duration, length of stay (LOS), and opioid analgesic use.
• Constipation defined as >48 hours without a bowel movement; interventions like bowel regimens and stool softeners were recorded.

Main Results:

• A high prevalence of postoperative constipation was observed in 69% of patients (146/213).
• Constipation was significantly associated with longer postoperative bedrest and increased morphine equivalent dose (MED) during the postoperative period.
• Postoperative constipation independently predicted a longer length of stay (LOS), but did not correlate with increased cerebrospinal fluid (CSF) leaks.

Conclusions:

• High rates of postoperative constipation occur after ESBS, likely influenced by immobilization and opioid use.
• Implementing standing bowel regimens should be considered for ESBS patients to mitigate constipation.
• No increased risk of postoperative CSF leaks was found in patients experiencing constipation.