Epidemiology
Ileus is commonly seen in the postoperative setting. Prevalence is difficult to assess because ileus is often considered a normal consequence of surgery so is not always reported as a complication. Furthermore, the various definitions in the literature are inconsistent, making the incidence even more difficult to quantify.[5][6]
About 22 million inpatient surgical procedures are performed each year in the US, and about 2.7 million of these patients develop postoperative ileus lasting more than one day.[7] Laparotomy is reported to be associated with up to 10% rate of ileus.[8] Postoperative ileus occurs in up to 1 in 8 patients undergoing abdominal surgery but it can also occur following other types of surgery such as cardiac or orthopedic procedures.[9][10][11][12][13]
Postoperative ileus is responsible for a significant prolongation of hospital stay, 30-day readmission, and for significant healthcare costs.[14][15] Approximately 10% of patients are readmitted to hospital after undergoing major abdominal surgery, and approximately half of these readmissions are due to delayed onset of postoperative ileus.[16] Ileus also increases hospital costs due to necessary testing, such as computed tomographic scans, when the patients are readmitted, which means postoperative ileus results in costs comparable to those for other more serious postoperative complications.[17]
Risk factors
This is a major risk factor.
The stress responses to incision of the peritoneum, to bowel manipulation, and to general anesthesia, and postoperative factors such as immobilization, use of analgesics, pain, and bowel rest, contribute to the development of ileus.[3]
Particularly sodium, potassium, chloride, magnesium, and calcium.
May be a consequence of ileus or an exacerbating factor.
Patients who are "nil per os" (nil by mouth), and who may have a nasogastric tube in place or are vomiting, are predisposed to abnormalities such as hypochloremia or hypokalemia.
In turn, these or other electrolyte problems may interfere with the normal motility of the bowel, exacerbating the condition.
Opioid-based analgesics interfere with gastrointestinal motility.[3] This often manifests as severe constipation, but may also present as ileus.
Some anticholinergic and anesthetic agents (e.g., atropine, halothane, enflurane) affect motility, contributing to the development of postoperative ileus.[27]
Gastroparesis can be a complication of diabetes mellitus.
Autoimmune or infectious diseases, such as scleroderma or Chagas disease, are associated with motility disorders and may exacerbate ileus.
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