Impact of Irritable Bowel Syndrome on Surgical Complexity and Perioperative Parameters in Elective Spinal Fusion

Introduction: Studies have shown that patients with irritable bowel syndrome (IBS) undergo spine surgery more often than patients without IBS, possibly due to an altered sensorium. However, there is sparse literature regarding the surgical complexity and perioperative parameters of these patients when undergoing spinal fusion surgery.

Methods: The National Readmissions Database was retrospectively reviewed between 2010 to 2013 and included 55,607,174 inpatient hospitalizations. ICD-9 codes were extracted for adult patients with and without IBS that underwent elective spinal fusion surgery. Age, sex, comorbidities, surgical approaches/procedures, discharge disposition, 90-day readmission rates, and primary reasons for readmission were compared based on IBS diagnosis.

Results: Across 268,904 spinal fusion patients, 5.3% had IBS. IBS patients were older (60.0+/-13.3 vs 56.8+/-13.1) and female (64.6% vs 53.6%). They exhibited more arthritis (5.5% vs 3.2%), obesity (16.5% vs 11.5%), and diabetes (17.5% vs 15.7%) (p < 0.0001). IBS patients more frequently underwent thoracolumbar spinal surgery (91.9% vs 64.5%) and more frequently underwent multi-level fusions (4-8 levels fused, 10.2% vs 6.6%) (p < 0.0001). They had prolonged length of stay (5.2+/-5.4 vs 2.8+/-2.9 days) and non-home discharge (16.2% vs 7.8%) (p < 0.0001). There was no difference in average time to first readmission (38.9+/-27.1 vs 40.3+/-26.3 days, p=0.40) between groups; however, patients with IBS exhibited a higher 90-day readmission rate (1.7% vs 1.4%, p=0.005) primarily due to graft or implant device complications. When controlling for preoperative differences, IBS diagnosis alone was not independently associated with 90-day readmission (p>0.05), but it was independently associated with increased odds of multi-level fusion (4-8 levels, OR:1.1, p=0.03).

Conclusion : IBS diagnosis was associated with statistically significant differences in overall comorbidity and surgical characteristics for patients undergoing elective primary spinal fusion. IBS patients were more surgically complex due to comorbidities and having more extensive thoracolumbar spinal fusions compared to non-IBS patients. This added complexity may have driven the higher rate of 90-day readmissions.