Top

International Journal of Colorectal Disease

Published in:

01-02-2019 | Original Article

Risk factors for ileus after hip and knee arthroplasty

Authors: Antonio Klasan, Fedor Amic, Philipp Dworschak, Goran Madzarac, Thomas Jan Heyse, Thomas Neri

Published in: International Journal of Colorectal Disease | Issue 2/2019

Abstract

Purpose

Postoperative ileus (POI) is one of the complications that can occur after every surgical procedure including arthroplasty. It can have detrimental consequences for the patient and portrays an economic burden on health care systems. The risk factors for POI after arthroplasty described in the literature are scarce and include hip arthroplasty, male gender and previous abdominal surgery. The purpose of the study was to determine the risk factors for POI after hip and knee arthroplasty.

Methods

A retrospective review of 2760 patients undergoing primary hip and knee arthroplasty was performed. An in-depth analysis of patient history and physical operative and postoperative course was reviewed and statistically analyzed in a univariate and multivariate setting.

Results

Overall incidence of POI was 0.54%. History of myocardial infarction and chronic kidney disease were statistically significant risk factors for developing POI after arthroplasty with values of p = 0.023 and p = 0.004, respectively. Other risk factors included previous abdominal surgery (p < 0.001) and hip arthroplasty (p = 0.026). Age or gender correlations were not observed.

Conclusions

Although postoperative ileus is an uncommon complication after joint arthroplasty, in addition to the known risk factors of male age, hip arthroplasty, and previous abdominal surgery, this study describes two previously unknown risk factors: chronic kidney disease and history of myocardial infarction. Patients with these risk factors should be monitored closely for developing postoperative ileus.

Jauregui JJ, Cherian JJ, Pierce TP, Beaver WB, Issa K, Mont MA (2015) Long-term survivorship and clinical outcomes following total knee arthroplasty. J Arthroplast 30:2164–2166. https://doi.org/10.1016/j.arth.2015.05.052 CrossRef

Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519. https://doi.org/10.1016/S0140-6736(07)60457-7 CrossRefPubMed

Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am 89:526–533. https://doi.org/10.2106/JBJS.F.00952 CrossRefPubMed

Livingston EH, Passaro EP (1990) Postoperative ileus. Dig Dis Sci 35:121–132CrossRefPubMed

Huge A, Kreis ME, Jehle EC, Ehrlein HJ, Starlinger M, Becker HD, Zittel TT (1998) A model to investigate postoperative ileus with strain gauge transducers in awake rats. J Surg Res 74:112–118. https://doi.org/10.1006/jsre.1997.5245 CrossRefPubMed

Bederman SS, Betsy M, Winiarsky R, Seldes RM, Sharrock NE, Sculco TP (2001) Postoperative ileus in the lower extremity arthroplasty patient. J Arthroplast 16:1066–1070. https://doi.org/10.1054/arth.2001.27675 CrossRef

Parvizi J, Han S-B, Tarity TD, Pulido L, Weinstein M, Rothman RH (2008) Postoperative ileus after total joint arthroplasty. J Arthroplast 23:360–365. https://doi.org/10.1016/j.arth.2007.12.019 CrossRef

Weinstein MA, Keggi JM, Zatorski LE, Keggi KJ (2002) One-stage bilateral total hip arthroplasty in patients > or = 75 years. Orthopedics 25:153–156PubMed

Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F (2004) Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 421:155–161CrossRef

10.

Berend KR, Lombardi AV, Mallory TH, Dodds KL, Adams JB (2004) Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism. J Arthroplast 19:82–86CrossRef

11.

O. Vilz T, Stoffels B, Strassburg C, H. Schild H, C. Kalff J (2017) Ileus in adults. Dtsch Arztebl Int 114:508–518 . doi: 10.3238/arztebl.2017.0508

12.

Tevis SE, Carchman EH, Foley EF, Harms BA, Heise CP, Kennedy GD (2015) Postoperative ileus–more than just prolonged length of stay? J Gastrointest Surg 19:1684–1690. https://doi.org/10.1007/s11605-015-2877-1 CrossRefPubMed

13.

Sibia US, Mandelblatt AE, Callanan MA, MacDonald JH, King PJ (2017) Incidence, risk factors, and costs for hospital returns after total joint arthroplasties. J Arthroplast 32:381–385. https://doi.org/10.1016/j.arth.2016.08.003 CrossRef

14.

Barletta JF, Senagore AJ (2014) Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy. World J Surg 38:1966–1977. https://doi.org/10.1007/s00268-014-2506-2 CrossRefPubMed

15.

Asgeirsson T, El-Badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ (2010) Postoperative ileus: it costs more than you expect. J Am Coll Surg 210:228–231. https://doi.org/10.1016/j.jamcollsurg.2009.09.028 CrossRefPubMed

16.

Ansari D, Gianotti L, Schröder J, Andersson R (2013) Fast-track surgery: procedure-specific aspects and future direction. Langenbeck’s Arch Surg 398:29–37. https://doi.org/10.1007/s00423-012-1006-9 CrossRef

17.

Yang JH, Yoon JR, Oh CH, Kim TS (2012) Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees. Knee Surg Sports Traumatol Arthrosc 20:517–523. https://doi.org/10.1007/s00167-011-1590-1 CrossRefPubMed

18.

Thompson M, Magnuson B (2012) Management of postoperative ileus. Orthopedics 35:213–217. https://doi.org/10.3928/01477447-20120222-08 CrossRefPubMed

19.

Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972. https://doi.org/10.1007/s11605-013-2148-y CrossRefPubMed

20.

Venara A, Slim K, Regimbeau J-M, Ortega-Deballon P, Vielle B, Lermite E, Meurette G, Hamy A (2017) Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery. Int J Color Dis 32:797–803. https://doi.org/10.1007/s00384-017-2788-6 CrossRef

21.

Ram CVS, Giles TD (2010) The evolving definition of systemic arterial hypertension. Curr Atheroscler Rep 12:155–158. https://doi.org/10.1007/s11883-010-0107-6 CrossRefPubMed

22.

Harter K, Levine M, Henderson SO (2015) Anticoagulation drug therapy: a review. West J Emerg Med 16:11–17. https://doi.org/10.5811/westjem.2014.12.22933 CrossRefPubMedPubMedCentral

23.

Lu L, Liu M, Sun R, Zheng Y, Zhang P (2015) Myocardial infarction: symptoms and treatments. Cell Biochem Biophys 72:865–867. https://doi.org/10.1007/s12013-015-0553-4 CrossRefPubMed

24.

Cassar A, Holmes DR, Rihal CS, Gersh BJ (2009) Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc 84:1130–1146. https://doi.org/10.4065/mcp.2009.0391 CrossRefPubMedPubMedCentral

25.

(2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33:S62–S69 . doi: https://doi.org/10.2337/dc10-S062, 2009

26.

Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41. https://doi.org/10.1159/000180580 CrossRefPubMed

27.

Thomas R, Kanso A, Sedor JR (2008) Chronic kidney disease and its complications. Prim Care 35:329–vii. https://doi.org/10.1016/j.pop.2008.01.008 CrossRefPubMedPubMedCentral

28.

Al Maaieh MA, Du JY, Aichmair A, Huang RC, Hughes AP, Cammisa FP, Girardi FP, Sama AA (2014) Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. Spine 39:688–694. https://doi.org/10.1097/BRS.0000000000000238 CrossRefPubMed

29.

Fineberg SJ, Nandyala SV, Kurd MF, Marquez-Lara A, Noureldin M, Sankaranarayanan S, Patel AA, Oglesby M, Singh K (2014) Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J 14:1680–1685. https://doi.org/10.1016/j.spinee.2013.10.015 CrossRefPubMed

30.

Ritter MA, Harty LD (2004) Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res 428:84–86CrossRef

31.

Yu C, Tan S, Wang Z, Deng B, Li J, Wang Q, Zhou C, Kang X, Yu Z, Zhuang S (2018) Chronic kidney disease elicits an intestinal inflammation resulting in intestinal dysmotility associated with the activation of inducible nitric oxide synthesis in rat. Digestion 97:205–211. https://doi.org/10.1159/000481618 CrossRefPubMed

32.

Vaziri ND, Wong J, Pahl M, Piceno YM, Yuan J, DeSantis TZ, Ni Z, Nguyen T-H, Andersen GL (2013) Chronic kidney disease alters intestinal microbial flora. Kidney Int 83:308–315. https://doi.org/10.1038/ki.2012.345 CrossRefPubMed

33.

Strid H, Simrén M, Stotzer P-O, Ringström G, Abrahamsson H, Björnsson ES (2003) Patients with chronic renal failure have abnormal small intestinal motility and a high prevalence of small intestinal bacterial overgrowth. Digestion 67:129–137. https://doi.org/10.1159/000071292 CrossRefPubMed

34.

Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241. https://doi.org/10.1056/NEJM199007263230405 CrossRefPubMed

35.

Sandek A, Bauditz J, Swidsinski A, Buhner S, Weber-Eibel J, von Haehling S, Schroedl W, Karhausen T, Doehner W, Rauchhaus M, Poole-Wilson P, Volk H-D, Lochs H, Anker SD (2007) Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol 50:1561–1569. https://doi.org/10.1016/j.jacc.2007.07.016 CrossRefPubMed

36.

Sandek A, Bjarnason I, Volk H-D, Crane R, Meddings JB, Niebauer J, Kalra PR, Buhner S, Herrmann R, Springer J, Doehner W, von Haehling S, Anker SD, Rauchhaus M (2012) Studies on bacterial endotoxin and intestinal absorption function in patients with chronic heart failure. Int J Cardiol 157:80–85. https://doi.org/10.1016/j.ijcard.2010.12.016 CrossRefPubMed

37.

Pasini E, Aquilani R, Testa C, Baiardi P, Angioletti S, Boschi F, Verri M, Dioguardi F (2016) Pathogenic gut flora in patients with chronic heart failure. JACC: Heart Failure 4:220–227. https://doi.org/10.1016/j.jchf.2015.10.009 CrossRefPubMed

38.

Wolthuis AM, Bislenghi G, Lambrecht M, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D’Hoore A (2017) Preoperative risk factors for prolonged postoperative ileus after colorectal resection. Int J Colorectal Dis 32:883–890. https://doi.org/10.1007/s00384-017-2824-6 CrossRefPubMed

39.

Menendez ME, Ring D, Bateman BT (2015) Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 473:2402–2412. https://doi.org/10.1007/s11999-015-4173-5 CrossRefPubMedPubMedCentral

40.

Shi Y, Zhang XP, Qin H, Yu YJ (2017) Naso-intestinal tube is more effective in treating postoperative ileus than naso-gastric tube in elderly colorectal cancer patients. Int J Color Dis 32:1047–1050. https://doi.org/10.1007/s00384-017-2760-5 CrossRef

41.

Lambrichts DPV, Boersema GSA, Tas B, Wu Z, Vrijland WW, Kleinrensink G-J, Jeekel J, Lange JF, Menon AG (2017) Nicotine chewing gum for the prevention of postoperative ileus after colorectal surgery: a multicenter, double-blind, randomised, controlled pilot study. Int J Color Dis 32:1267–1275. https://doi.org/10.1007/s00384-017-2839-z CrossRef

Title: Risk factors for ileus after hip and knee arthroplasty
Authors: Antonio Klasan
Fedor Amic
Philipp Dworschak
Goran Madzarac
Thomas Jan Heyse
Thomas Neri
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 2/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3184-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk factors for ileus after hip and knee arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Soluble intercellular adhesion molecule-1 is a prognostic marker in colorectal carcinoma

Infectious proctitis: a necessary differential diagnosis in ulcerative colitis

A rare case of peritoneal deposits with carbon pigmentation after preoperative endoscopic tattooing for sigmoid colon cancer

Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review

Long-term hospital mortality due to small bowel obstruction after major colorectal surgery in a national cohort database

Enterocutaneous fistula in severely active Crohn’s disease: preoperative anti-TNF alpha treatment to limit bowel resection—report of a case