title: A novel approach to prevent post-operative ileus after continuous-flow left ventricular assist device implantation: A retrospective cohort study.
abstract: BACKGROUND
  Patients with postoperative ileus (POI), a common post-surgical event, experience intense discomfort. Various treatments targeting prevention of POI have shown to have an unpredictable effect. We introduced a novel postoperative bowel management protocol in patients implanted with a continuous-flow left ventricular assist device (CF-LVAD). The effect of this protocol on POI was evaluated.
  
  
  METHODS
  Patients receiving an old bowel management protocol (OBMP; 01/2007-03/2009) were compared with those receiving a new bowel management protocol (NBMP; 04/2009-12/2013). The OBMP consisted of advancing the diet as tolerated, bisacodyl suppositories and enemas with the goal of a bowel movement (BM) every 3 days. The NBMP consisted of clear liquids until first BM is achieved, then full liquids until the second BM, then advancing to goal diet. Docusate is given on postoperative day (POD) 1 and bisacodyl PR on POD2 with enemas if ileus develops. Enemas are added POD3 if no BM has occurred. Polyethylene glycol is considered daily for patients prone to constipation. The goal is a BM every 2 days. Patients were made nil per os (NPO) with any signs of ileus.
  
  
  RESULTS
  One hundred eighteen patients were implanted with CF-LVADs during the study period. The incidence of ileus significantly decreased from 19% in the OBMP group to 4% percent in the NBMP group (p < 0.05). In-hospital mortality was not different between the two groups (6% vs. 2% p = 0.35).
  
  
  CONCLUSIONS
  A novel postoperative bowel management protocol successfully decreased the incidence of POI following CF-LVAD implant surgery at our institution.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Abbasali
authors.initials: A
authors.lastname: Badami
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Erika A
authors.initials: EA
authors.lastname: Fehrenbach Prell
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Murray
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Maryl R
authors.initials: MR
authors.lastname: Johnson
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Shahab A
authors.initials: SA
authors.lastname: Akhter
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Lucian
authors.initials: L
authors.lastname: Lozonschi
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Satoru
authors.initials: S
authors.lastname: Osaki
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA. Electronic address: lushaj@surgery.wisc.edu.
authors.forename: Entela
authors.initials: E
authors.lastname: Lushaj
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin-Madison Hospital and Clinics, Madison, WI, USA.
authors.forename: Takushi
authors.initials: T
authors.lastname: Kohmoto
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D045823:Ileus / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gastrointestinal complications; Ileus; Implantation; Ventricular assist device