Analysis of latent classes and influencing factors of postoperative ileus after transforaminal lumbar interbody fusion_West China Medical Journal

Authors：

JIANG Kun , WANG Lei , TANG Renqin , YU Yao , SHANG Fan ,  LUO Chunmei

Department of Orthopaedics, the Second Affiliated Hospital of Army Medical University (Xinqiao Hospital), Chongqing 400037, P. R. China;

Corresponding?author：

LUO Chunmei, Email: 871459572@qq.com

Keywords：

Transforaminal lumbar interbody fusion; postoperative ileus; latent class; influencing factors

DOI：

10.7507/1002-0179.202606022

Video：

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Objective To identify the potential categories of postoperative ileus (POI) after transforaminal lumbar interbody fusion (TLIF) and their influencing factors, so as to provide references for developing targeted nursing strategies. Methods Patients who underwent TLIF in the Department of Orthopedics, Army Medical University between August 2023 and January 2024 were conveniently selected. Data on patients’ general information, medical history, and preoperative, intraoperative, and postoperative conditions were collected through questionnaires and medical record reviews. Latent class analysis was used to categorize the gastrointestinal symptoms of POI, and multinomial logistic regression was applied to analyze the influencing factors. Results A total of 435 patients were included. The gastrointestinal symptoms of POI were classified into three latent categories: high abdominal pain and bloating class (204 cases), high nausea and vomiting class (46 cases), and weak gastrointestinal response class (185 cases). Multinomial logistic regression analysis showed that history of gastric disease (P=0.006) and time to first postoperative anal exhaust (P<0.001) were influencing factors for patients presenting with high abdominal pain and bloating symptoms. History of gastric disease (P<0.001) and low postoperative hemoglobin level (P=0.008) were influencing factors for patients presenting with high nausea and vomiting symptoms. Conclusions POI after TLIF can be categorized into three types: high abdominal pain and bloating class, high nausea and vomiting class, and weak gastrointestinal response class. Nurses should pay attention to the impact of gastric disease history, anemia, and postoperative flatus time on gastrointestinal function, strive to shorten preoperative fasting time, protect gastric mucosa, strengthen perioperative blood management, and adopt multimodal approaches to promote the recovery of gastrointestinal motility, thereby reducing the incidence of POI after lumbar fusion surgery.

Citation： JIANG Kun, WANG Lei, TANG Renqin, YU Yao, SHANG Fan, LUO Chunmei. Analysis of latent classes and influencing factors of postoperative ileus after transforaminal lumbar interbody fusion. West China Medical Journal, 2026, 41(9): 1420-1425. doi: 10.7507/1002-0179.202606022 Copy

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2.	Wolthuis AM, Bislenghi G, Fieuws S, et al. Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis[J]. Colorectal Dis, 2016, 18(1): O1-O9.
3.	Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus[J]. Curr Opin Clin Nutr Metab Care, 2018, 21(5): 394-398.
4.	Kehlet H, Holte K. Review of postoperative ileus[J]. Am J Surg, 2001, 182(5ASuppl): 3S-10S.
5.	Fineberg SJ, Nandyala SV, Kurd MF et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion[J]. Spine J, 2014, 14(8): 1680-1685.
6.	Al Maaieh MA, Du JY, Aichmair A, et al. Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2014, 39(8): 688-694.
7.	Ravinsky RA, Ouellet JA, Brodt ED, et al. Vertebral osteotomies in ankylosing spondylitis-comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review[J]. Evid Based Spine Care J, 2013, 4(1): 18-29.
8.	張鑫微, 張志軍, 賈若, 等. 真實世界腰椎融合術后胃腸功能障礙的影響因素分析及 Nomogram 預測模型建立[J]. 北京醫學, 2022, 44(4): 292-297.
9.	吳海波. 老年患者前路腰椎間融合術后腸梗阻的危險因素[J]. 頸腰痛雜志, 2022, 43(2): 197-200.
10.	李偲, 劉克玄, 鄧小明, 等. 術后胃腸功能障礙防治專家共識[J]. 國際麻醉學與復蘇雜志, 2021, 42(11): 1133-1142.
11.	Chapman SJ, Pericleous A, Downey C, et al. Postoperative ileus following major colorectal surgery[J]. Br J Surg, 2018, 105(7): 797-810.
12.	鄭旭, 顧小萍, 王琛. 胸腰椎融合術患者術后胃腸功能障礙的危險因素分析[J]. 中華醫學雜志, 2024, 104(3): 186-191.
13.	Feldheiser A, Aziz O, Baldini G, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice[J]. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
14.	吳新民, 羅愛倫, 田玉科, 等. 術后惡心嘔吐防治專家意見 (2012)[J]. 臨床麻醉學雜志, 2012, 28(4): 413-416.
15.	李亞雯, 羅春梅, 杜紅霞, 等. 胃腸耐受階梯化進食進飲方案在全身麻醉后路腰椎融合術后病人中的應用[J]. 護理研究, 2020, 34(18): 3315-3318.
16.	魏修朵, 方臘梅. 規范穴位按揉方案改善腰椎術后患者腹脹的效果觀察[J]. 中西醫結合護理, 2024, 10(6): 79-83.
17.	Gong J, Xie Z, Zhang T, et al. Randomised clinical trial: prucalopride, a colonic pro-motility agent, reduces the duration of post-operative ileus after elective gastrointestinal surgery[J]. Aliment Pharmacol Ther, 2016, 43(7): 778-789.
18.	Park IJ, Lee JH, Kye BH, et al. Effects of probiotics on the symptoms and surgical outcomes after anterior re-section of colon cancer (Postcare): a randomized, double-blind, placebo-controlled trial[J]. J Clin Med, 2020, 9(7): 2181.
19.	Yakkanti RR, Miller AJ, Smith LS, et al. Impact of early mobilization on length of stay after primary total knee arthroplasty[J]. Ann Transl Med, 2019, 7(4): 69.
20.	卞立群, 鄒多武, 柯曉, 等. 四磨湯口服液用于慢性胃腸疾病治療及腹部手術后腸胃功能康復的專家共識[J]. 中華中醫藥學刊, 2021, 39(7): 254-258.
21.	肖祥. 香檳方結合針足三里對腰椎融合術后胃腸功能的影響[D]. 廣州: 廣州中醫藥大學, 2018.
22.	Chen KB, Lu YQ, Chen JD, et al. Transcutaneous electroacupuncture alleviates postoperative ileus after gastrectomy: a randomized clinical trial[J]. World J Gastrointest Surg, 2018, 10(2): 13-20.
23.	易懷秀, 顧平, 劉言. 腹腔鏡術后咀嚼口香糖促進胃腸道功能恢復效果的 Meta 分析[J]. 中國護理管理, 2020, 20(8): 1196-1203.
24.	沈洪, 張露, 葉柏, 等. 便秘中醫診療專家共識意見 (2017)[J]. 北京中醫藥, 2017, 36(9): 771-776, 784.
25.	Mazor Y, Jones M, Andrews A, et al. Anorectal biofeedback for neurogenic bowel dysfunction in incomplete spinal cord injury[J]. Spinal Cord, 2016, 54(12): 1132-1138.
26.	Akta? A, Kayaalp C, Ate? M, et al. Risk factors for postoperative ileus following loop ileostomy closure[J]. Turk J Surg, 2020, 36(4): 333-339.
27.	Elnaghy KM, Nasr I, Kamal EM, et al. Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate[J]. Ain Shams J Anesthesiol, 2021, 13: 51.
28.	Zhang L, Li Y, Liu D, et al. Combined use of tranexamic acid and rivaroxaban in posterior lumbar in-terbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis—a prospective, stratified, randomized, controlled trial[J]. Int Orthop, 2020, 44: 2079-2087.
29.	王少杰. 隱性失血中醫治療思路探析[J]. 中國民間療法, 2016, 24(11): 7-9.

1. Gero D, Gié O, Hübner M, et al. Postoperative ileus: in search of an international consensus on definition, diagnosis, and treatment[J]. Langenbecks Arch Surg, 2017, 402(1): 149-158.
2. Wolthuis AM, Bislenghi G, Fieuws S, et al. Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis[J]. Colorectal Dis, 2016, 18(1): O1-O9.
3. Smeets BJJ, Luyer MDP. Nutritional interventions to improve recovery from postoperative ileus[J]. Curr Opin Clin Nutr Metab Care, 2018, 21(5): 394-398.
4. Kehlet H, Holte K. Review of postoperative ileus[J]. Am J Surg, 2001, 182(5ASuppl): 3S-10S.
5. Fineberg SJ, Nandyala SV, Kurd MF et al. Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion[J]. Spine J, 2014, 14(8): 1680-1685.
6. Al Maaieh MA, Du JY, Aichmair A, et al. Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion[J]. Spine (Phila Pa 1976), 2014, 39(8): 688-694.
7. Ravinsky RA, Ouellet JA, Brodt ED, et al. Vertebral osteotomies in ankylosing spondylitis-comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review[J]. Evid Based Spine Care J, 2013, 4(1): 18-29.
8. 張鑫微, 張志軍, 賈若, 等. 真實世界腰椎融合術后胃腸功能障礙的影響因素分析及 Nomogram 預測模型建立[J]. 北京醫學, 2022, 44(4): 292-297.
9. 吳海波. 老年患者前路腰椎間融合術后腸梗阻的危險因素[J]. 頸腰痛雜志, 2022, 43(2): 197-200.
10. 李偲, 劉克玄, 鄧小明, 等. 術后胃腸功能障礙防治專家共識[J]. 國際麻醉學與復蘇雜志, 2021, 42(11): 1133-1142.
11. Chapman SJ, Pericleous A, Downey C, et al. Postoperative ileus following major colorectal surgery[J]. Br J Surg, 2018, 105(7): 797-810.
12. 鄭旭, 顧小萍, 王琛. 胸腰椎融合術患者術后胃腸功能障礙的危險因素分析[J]. 中華醫學雜志, 2024, 104(3): 186-191.
13. Feldheiser A, Aziz O, Baldini G, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice[J]. Acta Anaesthesiol Scand, 2016, 60(3): 289-334.
14. 吳新民, 羅愛倫, 田玉科, 等. 術后惡心嘔吐防治專家意見 (2012)[J]. 臨床麻醉學雜志, 2012, 28(4): 413-416.
15. 李亞雯, 羅春梅, 杜紅霞, 等. 胃腸耐受階梯化進食進飲方案在全身麻醉后路腰椎融合術后病人中的應用[J]. 護理研究, 2020, 34(18): 3315-3318.
16. 魏修朵, 方臘梅. 規范穴位按揉方案改善腰椎術后患者腹脹的效果觀察[J]. 中西醫結合護理, 2024, 10(6): 79-83.
17. Gong J, Xie Z, Zhang T, et al. Randomised clinical trial: prucalopride, a colonic pro-motility agent, reduces the duration of post-operative ileus after elective gastrointestinal surgery[J]. Aliment Pharmacol Ther, 2016, 43(7): 778-789.
18. Park IJ, Lee JH, Kye BH, et al. Effects of probiotics on the symptoms and surgical outcomes after anterior re-section of colon cancer (Postcare): a randomized, double-blind, placebo-controlled trial[J]. J Clin Med, 2020, 9(7): 2181.
19. Yakkanti RR, Miller AJ, Smith LS, et al. Impact of early mobilization on length of stay after primary total knee arthroplasty[J]. Ann Transl Med, 2019, 7(4): 69.
20. 卞立群, 鄒多武, 柯曉, 等. 四磨湯口服液用于慢性胃腸疾病治療及腹部手術后腸胃功能康復的專家共識[J]. 中華中醫藥學刊, 2021, 39(7): 254-258.
21. 肖祥. 香檳方結合針足三里對腰椎融合術后胃腸功能的影響[D]. 廣州: 廣州中醫藥大學, 2018.
22. Chen KB, Lu YQ, Chen JD, et al. Transcutaneous electroacupuncture alleviates postoperative ileus after gastrectomy: a randomized clinical trial[J]. World J Gastrointest Surg, 2018, 10(2): 13-20.
23. 易懷秀, 顧平, 劉言. 腹腔鏡術后咀嚼口香糖促進胃腸道功能恢復效果的 Meta 分析[J]. 中國護理管理, 2020, 20(8): 1196-1203.
24. 沈洪, 張露, 葉柏, 等. 便秘中醫診療專家共識意見 (2017)[J]. 北京中醫藥, 2017, 36(9): 771-776, 784.
25. Mazor Y, Jones M, Andrews A, et al. Anorectal biofeedback for neurogenic bowel dysfunction in incomplete spinal cord injury[J]. Spinal Cord, 2016, 54(12): 1132-1138.
26. Akta? A, Kayaalp C, Ate? M, et al. Risk factors for postoperative ileus following loop ileostomy closure[J]. Turk J Surg, 2020, 36(4): 333-339.
27. Elnaghy KM, Nasr I, Kamal EM, et al. Acute hypervolemic hemodilution combined with controlled hypotension to minimize blood loss during operations of spine fusion: remifentanil versus magnesium sulfate[J]. Ain Shams J Anesthesiol, 2021, 13: 51.
28. Zhang L, Li Y, Liu D, et al. Combined use of tranexamic acid and rivaroxaban in posterior lumbar in-terbody fusion safely reduces blood loss and transfusion rates without increasing the risk of thrombosis—a prospective, stratified, randomized, controlled trial[J]. Int Orthop, 2020, 44: 2079-2087.
29. 王少杰. 隱性失血中醫治療思路探析[J]. 中國民間療法, 2016, 24(11): 7-9.

West China Medical Journal

Analysis of latent classes and influencing factors of postoperative ileus after transforaminal lumbar interbody fusion

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