Abstract
Dear editor,
Recently. We were honored to read Professor Alzakri ‘s article ‘Effectiveness of a Preoperative Bowel Preparation Protocol for Patients With Adolescent Idiopathic Scoliosis to Decrease Postoperative Gastrointestinal Morbidities and the Hospital Length of Stay’. 1 In this study, the author compared the clinical data of patients with preoperative bowel preparation and those without preoperative bowel preparation, and concluded that the use of a bowel preparation protocol before scoliosis correction surgery for patients with adolescent idiopathic scoliosis can effectively decrease postoperative gastrointestinal morbidities and the hospital length of stay. We are very grateful for the author ‘s contribution, but we still have some problems to further explore.
First of all, although the author detailed the change of postoperative analgesic drugs in the article, the study did not discuss whether the transition time of postoperative analgesic drugs would affect the length of hospital stay. Studies have reported that the different transition time from intravenous injection to oral opioids after posterior spinal fusion for the treatment of adolescent idiopathic scoliosis will affect the length of hospital stay. A long transition time will increase the patient’s hospital stay. 2 Secondly, the authors did not explore the possible effects of intraoperative traction and spinal curvature on postoperative gastrointestinal symptoms. Both preoperative main curve correction <30% in traction/bending radiographs and preoperative main curve >90° are risk factors for postoperative gastrointestinal complications. The main reason for this phenomenon is that intraoperative orthopedic curvature may lead to lesions of visceral nerves and spinal nerves. At the same time, patients are more painful after surgery. Increasing the dose or frequency of opioid analgesics will increase the incidence of postoperative gastrointestinal complications. 3 In addition, although the author has unified the surgical method, we still hope that the author will elaborate on the surgical method for many peers to exchange and learn, and at the same time apply spinal cord detection during the operation. Different surgical methods cause different spinal cord stimulation during the operation, which may affect the occurrence of postoperative gastrointestinal symptoms. 3
Finally, despite the above problems, we are still very grateful for the author’s contribution in this field, and hope that our questions can be answered.
