(Research Hub Theater) Bowel Clean out Prior to Intrathecal Baclofen Pump Implantation: Effects on Acute Post-operative Gastrointestinal Complications

Background and/or Objectives: Intrathecal baclofen (ITB) pumps have been used for management of spasticity and dystonia. There is limited data on immediate post-operative complications such as GI adverse events after surgery for ITB pump related procedures. This study aimed to compare patients who underwent a pre-operative bowel cleanout to those who did not and the relationship with post-operative nausea, vomiting and constipation requiring an escalation of their bowel regimen.

Design: Retrospective cohort study.

Setting: Pediatric acute care hospital.

Participants: All patients who underwent new ITB pump and/or catheter placement from January 2015-December 2022.

Interventions: Preoperative bowel clean out.

Main Outcome Measures: Quantity of children requiring escalation of bowel program compared to home regimen after ITB implantation and rates of nausea and/or emesis after ITB implantation.

Results: Of the 97 procedures performed in the study period, including new pump and catheter implantations and catheter revisions, 62% (n= 60) were instructed to complete a bowel clean pre-operatively. There was a significant difference between patients who had emesis in those who did not undergo a bowel cleanout preoperatively compared to the patients that did undergo a bowel cleanout (p=0.018). A chi-square test of independence demonstrated there was no significant relationship between performance of a cleanout and the need to increase their bowel regimen post-operatively (chi squared value= 0.0062, p=0.93738).

Conclusions: Overall, it appears that escalation of a bowel regimen is typically required during a post-ITB implant admission regardless of if a preoperative bowel cleanout is performed. Therefore, it should be carefully considered for each individual patient. As constipation may contribute to emesis, an immediate escalation of the bowel regimen in the post-operative period should be considered.