Early Diet Liberalization After Anterior Lumbar Interbody Fusion Improves Postoperative Recovery: Study

Tiffany Bridges et al conducted a study to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF).

The purpose of the study was to evaluate postoperative outcomes and complications, such as post operative ileus (POI), length of stay (LOS), and urinary retention (POUR) based on diet status following anterior lumbar surgery. The findings of this study may serve to contribute to new spine specific Enhanced Recovery After Surgery (ERAS) protocols which can help surgeons and patients plan for optimization of the postoperative recovery period.

A retrospective review was performed for patients undergoing ALIF at three tertiary care institutions. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes.

Key findings of the study were:

• A total of 515 patients who underwent combined anterior (ALIF) and posterior (PLF or PLDF) lumbar surgery were included in the study.

• In total, 413 patients (80.2%) comprised the “Delayed Diet” group while 102 patients (19.8%) were in the “Full Diet” cohort.

• Demographic data (age, sex, race, ethnicity, BMI, diabetes, smoking status, CCI) was similar amongst both groups other than a greater percentage of male patients in the “Full Diet” group (61.8% vs 45.0%, P = .004)

• All other patients had a delay of at least 1 day (average 1.6 days) until a full diet was provided. This group was found to have a higher rate of postoperative ileus (10.2% vs 2.9%) and urinary retention (16.0% vs 3.9%).

• The readmission rate and percent of patients presenting to the emergency department within 90 days postoperatively were similar.

• On multivariate regression analysis, same-day, full-diet patients had decreased odds of developing urinary retention (OR = .17) and a shorter length of hospital stay (Estimate: -.99).

• Immediate full diet had no impact on the development of ileus (OR: .33).

The authors concluded – “An immediate postoperative full diet following an anterior approach to the lumbar spine was not found to be associated with an increased risk of postoperative ileus in patients deemed appropriate for early diet liberalization. Moreover, an early full diet was found to reduce length of hospitalization and risk of postoperative urinary retention. Reconsideration of postoperative diet protocols may help optimize patient outcomes and recovery.”

Study Design: Retrospective Cohort Study.

Further reading:

Early Diet Liberalization after Anterior Lumbar Interbody Fusion Improves Postoperative Recover Tiffany Bridges et al Global Spine Journal DOI: 10.1177/21925682231223461