The incidence and risk factors for post-operative ileus after spinal fusion surgery: a multivariate analysis.

PURPOSE: Post-operative ileus is a recognized complication of surgery. Little is known about the incidence and risk factors for post-operative ileus following spinal fusion surgery. To report the incidence and to assess for independent risk factors of post-operative ileus after spinal fusion surgery. METHODS: Retrospective single-centre cohort study. Patients with prolonged or recurrent post-operative ileus were identified by review of hospital stay documentation. Patients with post-operative ileus were matched 1:2 to a control cohort without post-operative ileus. Uni and multi variate analyses were performed on demographic, comorbidity, surgical indication, medication, and peri-operative details to identify risk factors for post-operative ileus. RESULTS: Two thousand six hundred and twenty five patients underwent spinal fusion surgery between January 2012 and December 2012. Forty nine patients with post-operative ileus were identified (1.9 %). Post-operative length of hospital stay was significantly longer for patients with post-operative ileus (9.3 ± 5.2 days), than control patients (5.5 ± 3.2 days) (p < 0.001). Independent risk factors were Lactated Ringers solution (aOR: 2.12, p < 0.001), 0.9 % NaCl solution (aOR: 2.82, p < 0.001), and intra-operative hydromorphone (aOR: 2.31, p < 0.01) and a history of gastro-oesophageal reflux (aOR: 4.86, p = 0.03). Albumin administration (aOR: 0.09, p < 0.01) was protective against post-operative ileus. CONCLUSIONS: Post-operative ileus is multifactorial in origin, and this study identified intra-operative hydromorphone and post-operative crystalloid fluid administration ≥2 litres as independent risk factors for the development of ileus.

Quality-of-life tradeoffs for hepatitis C treatment: do patients and providers agree?

BACKGROUND: The authors investigated differences between how patients and providers evaluate the quality-of-life tradeoffs associated with HCV treatment in computer-assisted interviews. They interviewed 92 treatment-naive HCV patients at gastroenterology, methadone maintenance, and HIV clinics at 3 hospitals in New York City and 23 physicians or nurses experienced in treating HCV at other hospitals in New York City. Subjects completed rating scale and standard gamble evaluations of current health and hypothetical descriptions of HCV symptoms and treatment side effects on a scale from 0 (death or worse than death) to 1 (best possible health). RESULTS: . Treatment side effects were rated worse by patients than providers using the rating scale (moderate side effects 0.42 v. 0.62; severe side effects 0.24 v. 0.40) and standard gamble (moderate side effects 0.61 v. 0.91; severe side effects 0.52 v. 0.75) (all P < or = 0.01). A year of severe side effects was equivalent to 4.1 years of mild HCV symptoms avoided for patients if they returned to their current health after treatment compared with 2.0 years avoided if they achieved average population health. For patients with depression symptoms, HCV treatment with severe side effects had lower value unless it would also improve their current health. CONCLUSIONS: . Patients have more concerns about treatment side effects than providers. Further research is warranted to develop HCV decision aids that elicit patient preferences and to evaluate how improved communication of the risks and benefits of HCV treatment and more effective treatment of depression may alter these preferences.

Culture independent analysis of ileal mucosa reveals a selective increase in invasive Escherichia coli of novel phylogeny relative to depletion of Clostridiales in Crohn's disease involving the ileum.

Intestinal bacteria are implicated increasingly as a pivotal factor in the development of Crohn's disease, but the specific components of the complex polymicrobial enteric environment driving the inflammatory response are unresolved. This study addresses the role of the ileal mucosa-associated microflora in Crohn's disease. A combination of culture-independent analysis of bacterial diversity (16S rDNA library analysis, quantitative PCR and fluorescence in situ hybridization) and molecular characterization of cultured bacteria was used to examine the ileal mucosa-associated flora of patients with Crohn's disease involving the ileum (13), Crohn's disease restricted to the colon (CCD) (8) and healthy individuals (7). Analysis of 16S rDNA libraries constructed from ileal mucosa yielded nine clades that segregated according to their origin (P<0.0001). 16S rDNA libraries of ileitis mucosa were enriched in sequences for Escherichia coli (P<0.001), but relatively depleted in a subset of Clostridiales (P<0.05). PCR of mucosal DNA was negative for Mycobacterium avium subspecies paratuberculosis, Shigella and Listeria. The number of E. coli in situ correlated with the severity of ileal disease (rho 0.621, P<0.001) and invasive E. coli was restricted to inflamed mucosa. E. coli strains isolated from the ileum were predominantly novel in phylogeny, displayed pathogen-like behavior in vitro and harbored chromosomal and episomal elements similar to those described in extraintestinal pathogenic E. coli and pathogenic Enterobacteriaceae. These data establish that dysbiosis of the ileal mucosa-associated flora correlates with an ileal Crohn's disease (ICD) phenotype, and raise the possibility that a selective increase in a novel group of invasive E. coli is involved in the etiopathogenesis to Crohn's disease involving the ileum.