title: Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy.
abstract: BACKGROUND
  Postoperative ileus remains a significant clinical and economic burden to the health care system. Over the last decade, several advances in both medical and surgical therapies have been made to reduce the incidence and severity of postoperative ileus. Despite these advances, though, the incidence of ileus remains high. This narrative review focuses on interventions aimed to prevent and treat postoperative ileus while presenting a step-by-step process for implementation of an evidenced-based strategy.
  
  
  METHODS
  A literature search was performed using Medline/PubMed, and articles related to postoperative ileus were identified. The bibliographies of all retrieved articles were reviewed to obtain additional articles of relevance.
  
  
  RESULTS
  There are many factors that can influence gastrointestinal recovery that can be categorized as management-, drug-, or surgery-related. While several strategies exist to improve gastrointestinal recovery, few have been shown to reduce length of hospital stay. These strategies are described here, along with a structured approach organized by preoperative, intraoperative, and postoperative considerations.
  
  
  CONCLUSIONS
  Postoperative ileus is associated with a significant clinical and economic burden to the health care system. Strategies such as the development of a multidisciplinary team and the creation of a multimodal protocol are encouraged with continuous quality assurance to assess outcomes at the local level.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy-Glendale, Midwestern University, 19555 N 59th Avenue, Glendale, AZ, 85308, USA, jbarle@midwestern.edu.
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
mesh_terms: D000767:Anesthesia, Epidural; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002985:Clinical Protocols; D017281:Cost of Illness; D013505:Digestive System Surgical Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D045823:Ileus / Q000191:economics / Q000517:prevention & control*; D010535:Laparoscopy; D007902:Length of Stay / Q000191:economics; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal