Risk Factors for Postoperative Ileus following Primary Total Hip Arthroplasty

Postoperative ileus (POI) is a feared complication following surgery. The purpose of this study was to (1) compare patient demographics between patients who developed and did not develop POI following primary total hip arthroplasty (THA), (2) compare in-hospital lengths of stay (LOS), and (3) identify patient-related risk factors associated with developing POI after primary THA. Using the 100% Medicare Standard Analytical Files from the PearlDiver from 2005 to 2014, patients developing POI within 3 days following primary THA were identified as the study cohort, whereas patients not developing POI served as the comparison cohort. Primary endpoints of the study included comparing patient demographics, in-hospital LOS, and identifying patient-related risk factors. A multivariate binomial logistic regression analysis was used to identify patient-related risk factors by calculating odds ratio (OR) for the risk of developing POI. A p-value less than 0.001 was considered to be statistically significant. The query yielded 335 patients (0.03%) who developed POI following their primary THA procedure. The study group was significantly different compared with controls with respect to age (p < 0.0001), sex (p < 0.0001), and prevalence of comorbid conditions. Patients who developed POI had longer in-hospital LOS (5 vs. 3 days, p < 0.0001). Risk factors associated with POI included electrolyte and fluid imbalance (OR: 3.06, p < 0.0001), male sex (OR: 2.86, p < 0.0001), and obesity (OR: 1.89, p < 0.0001). The study found significant differences among patients who did and did not develop POI following primary THA and several associated risk factors for the complication. Identification and adequate preoperative optimization of modifiable risk factors could potentially reduce the incidence of POI.