Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Global Spine Journal

Abstract

Introduction: Postoperative ileus (POI) is an infrequent but impactful complication following lumbar spine procedures. While well-characterized in abdominal surgery, spine-specific data remain limited, particularly regarding modifiable risk factors. Materials and Methods: We analyzed 41,164 patients who underwent elective lumbar spine surgery between 2018 and 2023 using the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Multivariable generalized estimating equation models were used to identify independent risk factors for POI. We also evaluated the association between POI and postoperative outcomes, including patient-reported outcome measures (PROMs). Results: POI occurred in 1.1% of patients (n = 447). Independent risk factors included older age (RR 1.01, p = .01), male sex (RR 2.06, p < .001), and Black race (RR 1.91, p < .001). Multilevel surgery was associated with increased risk: 2- level (RR 1.41, p = .003), 3-level (RR 1.48, p = .007), and ≥ 4-level procedures (RR 1.66, p = .031). Fusion procedures carried a near fivefold increased risk of POI (RR 4.63, p < .001). Conversely, early ambulation within 8 hours postoperatively was protective (RR 0.65, p < .001). Patients who developed POI showed less improvement in PROMs, with lower rates of achieving the 2-year minimal clinically important difference (MCID) for Numerical Rating Scale (NRS) leg pain (65% vs. 76%, p = .033) and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) (49% vs. 63%, p = .008). After covariate adjustment, POI was associated with higher complication rates (RR 1.57, p < .001), increased readmission risk (RR 1.46, p = .017), reduced likelihood of discharge to home (RR 0.93, p < .001), and a prolonged hospital stay by 2.82 days (p < .001). Conclusion: Although infrequent, POI is associated with significant morbidity after lumbar spine surgery, including prolonged hospitalization, increased complications, and worse long-term outcomes. Surgical invasiveness and delayed ambulation were key contributors, while early mobilization was strongly protective. These findings support incorporating early ambulation into enhanced recovery protocols and highlight opportunities to reduce POI burden through modifiable perioperative strategies.

Volume

16

Issue

2 Suppl

First Page

421S

Comments

Global Spine Congress, May 27-30, 2026, Istanbul, Turkey

Last Page

422S

DOI

10.1177/21925682261435810

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