Perioperative bowel regimens following posterior spinal fusions for adolescent idiopathic scoliosis: a systematic review.

Background: Bowel morbidity after posterior spinal fusions (PSFs) for adolescent idiopathic scoliosis (AIS) delays the advancement of postoperative oral diet and discharge. This systematic review aims to investigate the effectiveness of perioperative bowel regimens in reducing length of stay and postoperative bowel morbidity in these patients.

Materials and methods: We systematically searched MEDLINE, Embase, Cochrane, SPORTDiscus, and CINAHL for articles reporting on clinical results of PSFs for AIS patients. Demographic data, mean operative time and estimated blood loss, length of stay, time to first flatus and/or bowel movement, first oral intake, and postoperative pain scores were extracted from the selected studies.

Results: Six articles (n = 468 patients) met the final inclusion criteria. Only one study, which assessed oral methylnaltrexone, reported a significant reduction in the mean hospital length of stay (0.60 days, P < 0.05) and postoperative abdominal distension (17% versus 40%, P < 0.05); however, it was also the only study to report a significantly increased mean operative time (38.9 min, P = 0.03) and estimated blood loss (111.1 mL, P = 0.05) compared to the treatment group. Time to flatus, regular diet, postoperative opioid consumption, and pain scores did not differ significantly in any of the reported studies.

Conclusion: There is limited evidence to demonstrate any specific perioperative bowel regimen will decrease postpreparative bowel morbidity and/or length of stay. While not a treatment in isolation, oral methylnaltrexone may be a safe and effective adjunct to standard postoperative bowel regimens and may have a better patient tolerance profile.