Postoperative administration of naloxegol after spinal deformity surgery: analysis of 234 patients

Naloxegol, a peripherally acting mu-opioid receptor antagonist, is used to treat opioid-induced constipation. However, its effectiveness following adult spinal deformity surgery remains poorly understood. The objective of this study was to examine naloxegol's impact on postoperative bowel function in patients undergoing adult spinal deformity surgery.

A retrospective analysis was conducted of consecutive spinal deformity surgeries from a single surgeon's practice, comparing outcomes before and after the introduction of universal postoperative naloxegol administration (12.5 mg daily for 7 days). Multivariable logistic regression and propensity score-matched analyses were used to evaluate the relationship between naloxegol use and markers of postoperative ileus (POI).

Two hundred thirty-four patients (72.2% female, mean age 60.7 [SD 15.8] years, mean BMI 28.8 [SD 5.1]) were analyzed. One hundred fifty-four (65.8%) of these patients were opioid-naïve and 80 (34.1%) received naloxegol. The naloxegol group had significantly lower odds of lateral lumbar interbody fusion (OR 0.13, p = 0.0001) and shorter operative times (5.65 vs 6.75 hours, p = 0.0008). There was no statistical association between naloxegol and postoperative abdominal imaging, nasogastric tube placement, or gastroenterology consultation in either the matched or multivariate analyses (p > 0.05). A gastroenterology consultation (n = 15 patients, 6.5%) was positively associated with anterior lumbar interbody fusion (OR 5.54, p = 0.010) and diabetes (OR 12.37, p = 0.001) and negatively associated with preoperative opioid use (OR 0.18, p = 0.036). Postoperative abdominal imaging correlated positively with the number of vertebrae fused (OR 1.09, p = 0.031) and negatively with preoperative opioid use (OR 0.44, p = 0.026). Weighted time-to-event analysis found a difference in time to first flatus (p = 0.0282), but not in time to bowel movement (p = 0.5600) with naloxegol.

Postoperative naloxegol had no significant impact on bowel function recovery or markers of POI after spinal deformity surgery. Patients with a history of opioid exposure required fewer consultations and imaging. Further research is required to understand whether pre-induction administration impacts POI and return to bowel function.