Risk factors for postoperative ileus following transforaminal lumbar interbody fusion: a retrospective study

Transforaminal lumbar interbody fusion (TLIF) is a widely applicable spinal surgical technique. However, there is still a shortage of understanding of the risk of postoperative ileus (POI) following TLIF. We aimed to explore these potential risks and analyze the adverse effects that POI may cause.

A retrospective analysis was conducted on the medical records of patients undergoing TLIF at a single tertiary care institution between January 2018 and December 2024. Patients were divided into the POI group and non-POI group according to whether they presented with two or more gastrointestinal manifestations at 72 h postoperatively. Demographic characteristics, comorbidities, surgical factors, and postoperative factors were recorded. Univariate analysis was used to identify potential risk factors for POI, and multivariate logistic regression analysis was employed to determine independent risk factors. Finally, analyze the adverse effects of POI.

Thirty-six patients developed POI following TLIF, with an incidence rate of 8.04% (36/448). Multivariable logistic regression analysis identified anxiety disorders [odds ratio (OR) = 6.380, 95% confidence interval (95% CI) 1.793-22.711, P = 0.004], open TLIF (O-TLIF) (OR = 3.303, 95% CI 1.035-10.538, P = 0.044), application of patient-controlled analgesia (PCA) (OR = 8.962, 95% CI 1.066-75.308, P = 0.043), and crystalloid fluid administration within 72 h postoperatively (CFA-Postop72h) > 35 ml/kg/day (OR = 11.310, 95% CI 5.166-24.759, P < 0.001) as independent risk factors for POI following TLIF. There was a weak positive association between opioid consumption in PCA and the occurrence of POI (r = 0.223, P < 0.001). Patients with POI had significantly longer postoperative length of stay and a higher risk of hypoproteinemia than the control group (P < 0.05).

This study confirmed that anxiety disorders, O-TLIF, application of PCA, and excessive CFA-Postop72h are independent risk factors for POI following TLIF.