Journal List > Korean J Adult Nurs > v.28(6) > 1076432

Park, Yun, Kim, Yu, and Ham: Constipation in Patients following Orthopedic Surgery: Incidence and Influencing Factors

Abstract

Purpose

The purpose of this study was to identify the occurrences and the factors contributing to constipation in the post surgical period following major orthopedic surgery.

Methods

The sample included 133 patients who had surgery of the hip, knee, or spine. Patients were excluded from the study if there was a history of bowel surgery or constipation from chart review. Data were collected using questionnaires such as Korean version of Modified Barthel index (K-MBI), Hospital Anxiety and Depression Scale, and Constipation Assessment Scale (CAS) before surgery and on the third postoperative day.

Results

Reports of constipation occurred in 77 instances (57.9%). The first reported defecation was within 4.0±2.2 days following surgery. Mean days of first defecation of constipation group vs. non-constipation group was 5.5±1.7 days vs. 2.1±1.0 days. There were statistically significant differences between patients who reported than those who did not in terms of age, length of NPO period, postoperative ADL, and the reported incidents of preoperative and postoperative depressive symptoms. Postoperative ADL, age, and NPO period were significant influencing factors of constipation and explained 52.4% of the variance.

Conclusion

Constipation is a very common symptom for patients undergoing orthopedic surgery. These results indicate a need for improving patient's ADL after surgery to prevent constipation.

Figures and Tables

Table 1

Incidence of Constipation and Postoperative First Defecation in Patients underwent Orthopedic Surgery (N=133)

kjan-28-637-i001
Table 2

Comparison of Characteristics between Constipation Group and Non-constipation Group (N=133)

kjan-28-637-i002

NPO=Nil per os[Latin for "nothing by mouth"], IV PCA=intravenous patient controlled analgesia.

Table 3

Comparison of ADL, Depression, and Constipation Degree between Constipation Group and Non-constipation Group (N=133)

kjan-28-637-i003

ADL=activities of daily living, Pre-op=preoperative, POD=post operative day.

Table 4

Influencing Factors on Constipation in Patients following Orthopedic Surgery (N=133)

kjan-28-637-i004

ADL=activities of daily living, NPO=Nil per os [Latin for "nothing by mouth"].

Notes

This study was supported by the research grant of Asan Medical Center Nursing department in 2013.

References

1. De Souza MS. Effectiveness of nursing interventions in alleviating perceived problems among orthopaedic patients. J Orthop Nurs. 2002; 6:211–219.
2. Şendir M, Bűyűkyilmaz F, Aşti T, Gűrpinar Ş, Yazgan İ. Postoperative constipation risk assessment in Turkish orthopedic patients. Gastroenterol Nurs. 2012; 35(2):106–113. DOI: 10.1097/SGA.0b013e31824d2945.
crossref
3. Hsieh C. Treatment of constipation in older adults. Am Fam Physician. 2005; 72:2277–2284.
4. Martin NS, Nicolas RS, Gerhard H, Karl S, Enrico T, Oliver PG. Constipation after thoraco-lumbar fusion surgery. Clin Neurol Neurosurg. 2014; 126:137–142. DOI: 10.1016/j.clineuro.2014.08.036.
5. Davies EC, Green CF, Mottram DR, Pirmohamed M. The use of opioids and laxatives, and incidence of constipation, in patients requiring neck-of-femur (NOF)surgery: a pilot study. J Clin Pharm Ther. 2008; 33:561–566. DOI: 10.1111/j.1365-2710.2008.00949.x.
6. De Lillo AR, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol. 2000; 95(4):901–905. DOI: 10.1111/j.1572-0241.2000.01926.x.
crossref
7. Koloski NA, Jones M, Wai R, Gill RS, Byles J, Talley NJ. Impact of persistent constipation on health-related quality of life and mortality in older community-dwelling women. Am J Gastroenterol. 2013; 108:1152–1158. DOI: 10.1038/ajg.2013.137.
crossref
8. Pare P, Ferrazzi S, Thompson WG, Irvine EJ, Rance L. An epidemiological survey of constipation in Canada: definitions, rates, demographics, and predictors of health care seeking. Am J Gastroenterol. 2001; 96(11):3130–3137. DOI: 10.1111/j.1572-0241.2001.05259.x.
crossref
9. Nassar AP Jr, da Silva FM, de Cleva R. Constipation in intensive care unit: Incidence and risk factors. J Crit Care. 2009; 24(4):630.e9–630.e12. DOI: 10.1016/j.jcrc.2009.03.007.
crossref
10. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology. 1982; 83(3):529–534.
11. Kyle G. The older person: management of constipation. Br J Community Nurs. 2010; 15(2):58–64. DOI: 10.12968/bjcn.2010.15.2.46391.
crossref
12. Bouras EP, Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin North Am. 2009; 38(3):463–480. DOI: 10.1016/j.gtc.2009.06.001.
crossref
13. Shim HW. Constipation and activities of daily living of the institutionalized elderly. J Korean Acad Soc Nurs Educ. 2004; 10(2):252–261.
14. Kinnunen O. Study of constipation in a geriatric hospital, day hospital, old peoples home and at home. Aging (Milano). 1991; 3(2):161–170.
15. Cook SF, Lanza L, Zhou X, Sweeney CT, Goss D, Hollis K, et al. Gastrointestinal side effects in chronic opioid users: results from a population-based survey. Aliment Pharmacol Ther. 2008; 27(12):1224–1232. DOI: 10.1111/j.1365-2036.2008.03689.x.
crossref
16. Tuteja AK, Biskupiak J, Stoddard GJ, Lipman AG. Opioid induced bowel disorders and narcotic bowel syndrome in patients with chronic non-cancer pain. Neurogastroenterol Motil. 2010; 22(4):424–430. DOI: 10.1111/j.1365-2982.2009.01458.x.
17. Kim JH, Park JS. The effects of abdominal meridian massage on the degree of constipation among the patients with immobility after orthopedic surgery. Clin Nurs Res. 2006; 12(2):63–72.
18. Lee YA, Choi HJ, Jo YM, Lee IS. Effects of abdominal massage or lactic acid fermented milk for constipation in patients following spinal surgery. J Korean Clin Nurs Res. 2013; 19(2):208–217.
19. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, et al. Development of the Korean version of modified Barthel index: Multi-center study for subjects with stroke. J Korean Acad Rehabil Med. 2007; 31(3):283–297.
20. Oh SM, Min KJ, Park DB. A study on the standardization of the Hospital Anxiety and Depression Scale for Koreans. J Korean Neuropsychiatr Assoc. 1999; 38(2):289–296.
21. Yang S. Effects of fluid intake, dietary fiber supplement and abdominal muscle exercise on antipsychotic drug-induced constipation in schizophrenics. J Cathol Med Coll. 1992; 45(4):1501–1514.
22. The Korean Geriatrics Society. Geriatric Medicine. 2nd ed. Seoul: Medical Pulishing;2005. p. 304.
23. Rasmussen LS, Pedersen , PU . Constipation and defecation pattern the first 30 days after thoracic surgery. Scand J Caring Sci. 2010; 24(2):244–250. DOI: 10.1111/j.1471-6712.2009.00713.x.
24. Loren M, Cathy M, Barbara AP. Comparison of two bowel treatments to prevent constipation in post-surgical orthopedic patients. Int J Orthop Trauma Nurs. 2010; 14(2):75–81. DOI: 10.1016/j.joon.2009.07.049.
25. Orji EO, Olabode TO, Kuti O, Ogunniyi SO. A randomised controlled trial of early initiation of oral feeding after cesarean section. J Matern Fetal Neonatal Med. 2009; 22(1):65–71. DOI: 10.1080/14767050802430826.
crossref
26. Lee KN, Sung KW. The factors affecting the constipation of the elderly at nursing home. J Korean Acad Community Health Nurs. 2008; 19(4):575–586.
27. Park AJ, Lim NY, Kim YS, Song JH. Prevalence and risk of constipation among the institutionalized elderly. J East West Nurs Res. 2011; 17(1):57–65.
28. Choi JY. Effects of a constipation intervention program on inpatients defecation. J Korean Acad Nurs. 2004; 34(1):72–80.
crossref
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