Association between post-operative mobility restrictions and acute colonic pseudo-obstruction after spinal fixation in major trauma patients: a retrospective cohort study

Abstract

Abstract Purpose Acute colonic pseudo-obstruction (ACPO) is a common and potentially serious complication of surgical and trauma care. A possible contributor to ACPO development is impaired mobility. Major trauma patients, particularly those with spinal trauma, are at risk of prolonged mobility restrictions. The aim of this study was to assess the association between impaired mobility and the development of ACPO in major trauma patients undergoing acute thoraco-lumbar spinal fixation. Methods A retrospective cohort study involving major trauma patients admitted to a tertiary trauma facility was performed. The Hospital Trauma Registry was utilised to identify consecutive major trauma patients having urgent thoraco-lumbar spinal fixation. ACPO was defined as dilation of the transverse colon > 6cm or caecum > 9cm without mechanical cause. Immobility was defined by proxy as surgeon-prescribed mobility restrictions. Analysis was performed using multivariable logistic regression. Results ACPO occurred in 34 of 454 patients studied (7.5%). Colonoscopic decompression was required twice. Neostigmine and surgical resection were not required. There was no ACPO-related mortality. On multivariable regression, adjusted for confounding variables, post-operative mobility restrictions were associated with a three-fold increase in odds of ACPO (Odds Ratio 3.0; 95% confidence interval 1.1–8.2, P = 0.03). Conclusion ACPO was a common, although low-morbidity complication in this cohort. Surgically-prescribed mobility restrictions were associated with higher odds of ACPO in major trauma patients having thoraco-lumbar spinal fixation. Attention should be given to early mobilisation, where possible, in these patients.