Characterizing postoperative paralytic ileus as evidence for future research and clinical practice

Postoperative ileus, a delay of gastrointestinal (GI) motility beyond 3 days, is common in patients after GI surgery. This disorder increases length of hospital stay and costs millions of dollars annually. This study was done to determine clinical factors associated with paralytic ileus. An interdisciplinary team developed a data collection tool based on eight hypotheses derived from a review of literature on factors that contribute to ileus. In a retrospective medical record review of 101 patients who had abdominal surgery, 44 developed postoperative ileus and 57 did not. Data analysis found that three factors were statistically significant in reducing ileus: (1) early postoperative introduction of fluids and food, (2) avoidance of positive fluid balance exceeding 1,000 ml, and (3) avoiding potassium elevations over a 3-day period. A trend identified that the use of nonsteroidal anti-inflammatory drugs could reduce the incidence of ileus. Clinical implications include the importance of encouraging early oral intake, monitoring fluid intake and output in postoperative patients, and identifying positive fluid balance early to prevent it from continuing.