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.
