Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Theodore V. Nguyen; Ellen M. Hong; Benjamin F. Bitner; Michelle Chernyak; Daniella Chan; Katelyn K. Dilley; Arash Abiri; Ji Y. Li; Sina J. Torabi; Jonathan C. Pang; Frank P.K. Hsu; Edward C. Kuan

doi:10.1055/s-0044-1791806

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2025; 86(05): 547-555
DOI: 10.1055/s-0044-1791806

Original Article

Prevalence and Impact of Constipation on Reconstructive Outcomes Following Endoscopic Skull Base Surgery

Theodore V. Nguyen^*

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Ellen M. Hong^*

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Benjamin F. Bitner

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Michelle Chernyak

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Daniella Chan

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Katelyn K. Dilley

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Arash Abiri

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Ji Y. Li

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Sina J. Torabi

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Jonathan C. Pang

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

,

Frank P.K. Hsu

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

²Department of Neurological Surgery, University of California, Irvine, Orange, California, United States

,

Edward C. Kuan

¹Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, Orange, California, United States

²Department of Neurological Surgery, University of California, Irvine, Orange, California, United States

› Author Affiliations

Abstract

Objective

Postoperative constipation in endoscopic skull base surgery (ESBS) may provoke undesired straining, which, in theory, may create intracranial pressure shifts and impact skull base reconstruction. The purpose of this study is to assess the prevalence and contributing factors to postoperative constipation after ESBS, and whether this impacts reconstructive outcomes.

Methods

Patients undergoing ESBS between July 2018 and December 2022 at a single-center, tertiary academic skull base surgery program were retrospectively reviewed. Chart reviews were performed to identify average bowel movements per day, indication for surgery, age, sex, body mass index (BMI), history of chronic pain, length of postoperative bedrest, length of stay (LOS), and postoperative use of opioid analgesics. Additionally, use of a standing stool bowel regimen, as-needed (PRN) stool softeners/laxatives, and enemas were recorded. Constipation was defined as greater than 48 hours without a bowel movement.

Results

In total, 213 patients (115 with intradural pathologies) were identified, of which 146 (69%) patients had postoperative constipation. Postoperative constipation was associated with longer bedrest (1.86 ± 0.20 vs. 1.06 ± 0.12 days; p = 0.011); increased morphine equivalent dose (MED) during postoperative days 2, 3, 5, and 6 (all p < 0.05); and total postoperative MED (106.70 ± 14.01 vs. 46.88 ± 8.44 mg; p < 0.001). Additionally, postoperative constipation was an independent predictor of LOS (p = 0.009). There were no differences in postoperative cerebrospinal fluid (CSF) leak between the groups (p = 0.622).

Conclusion

Postoperative constipation rates were high after ESBS and likely causative factors include increased immobilization and postoperative opioid use. Standing bowel regimens should be considered in ESBS patients. However, there was no increased rate of postoperative CSF leaks.

Keywords

skull base reconstruction outcomes - postoperative - analgesia - opioid - constipation - CSF leak

Full Text

References

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