Irritable bowel syndrome and its impact on utilization and outcomes in elective thoracolumbar fusion

Functional somatic syndromes have been associated with worse outcomes, but the impact of irritable bowel syndrome (IBS) remains unclear.

Is IBS associated with perioperative complications following thoracolumbar spinal fusion?

The 2021-2022 National Inpatient Sample was reviewed for adults with and without IBS undergoing elective thoracolumbar fusion surgery. Demographics, comorbidities, surgical factors, and postoperative outcomes were compared by IBS status. Logistic regression assessed the association between IBS and undergoing fusion after controlling for comorbidity and sociodemographic factors. Propensity score matching of pre- and intraoperative variables compared perioperative complications by IBS diagnosis.

Among 68,169 fusion patients, 2.1% had IBS. IBS patients were predominantly female (81.0% vs 53.7%, p < 0.0001) and similar in age to those without IBS. IBS patients had higher rates of nutritional deficiencies (5.4% vs 2.9%, p < 0.0001), electrolyte disorders (14.3% vs 11.5%, p = 0.001), arthritis (7.2% vs 4.3%, p < 0.0001), and osteoporosis (11.3% vs 5.8%, p < 0.0001) during admission. IBS was associated with increased odds (1.91, 95% CI[1.80, 2.02], p < 0.0001) of undergoing thoracolumbar fusion. After matching, IBS remained associated with increased odds of gastrointestinal complications (primarily ileus) (1.60, 95% CI[1.11, 2.33], p = 0.01) and prolonged stay (>3 days) (1.23, 95% CI[1.06, 1.43], p = 0.006).

IBS was associated with increased surgical utilization, greater comorbidity, and modestly worse inpatient postoperative outcomes. These patients demonstrated higher rates of nutritional deficiency and gastrointestinal complications, potentially due to dietary restrictions and inherent gastrointestinal irritability. IBS may represent a risk factor in thoracolumbar fusion and should be considered during preoperative counseling.