Implementation of a standardized postoperative ileus management pathway: a prospective single-center feasibility study

Abstract

Postoperative ileus (POI) remains one of the most frequent complications following gastrointestinal surgery, yet its management is highly variable due to limited evidence. We developed a standardized institutional management pathway for POI and prospectively evaluated its feasibility of implementation and clinical outcomes. This prospective single-center feasibility study included consecutive adult patients who developed POI requiring nasogastric tube (NGT) insertion after abdominal surgery between June 2023 and March 2024. Patients were managed according to a standardized institutional POI management pathway. The primary endpoint was pathway adherence. Secondary endpoints included NGT duration, NGT reinsertion, postoperative complications, and length of hospital stay. Out of 60 patients screened, 47 (78%) were included. In the per-pathway group (n = 40), median NGT duration was 2 days [IQR 2–4], and median hospital stay was 13 days [IQR 8–18] from surgery and 9 days [IQR 5–14] from POI diagnosis. Three of 47 patients (6%) required NGT reinsertion, and one episode of bronchoaspiration occurred during the study period. Overall, 40/47 patients (85%, 95% CI 72–93%) were managed according to the pathway without major deviations, and conservative management was successful in 38/40 patients (95%). Implementation of a standardized POI management pathway was feasible in this prospective single-center cohort, with high pathway adherence and no obvious safety signal. Larger multicenter controlled studies are warranted to evaluate both safety and clinical impact. This study has been registered by the Research Ethics Commission on human beings of the Canton de Vaud (CER-VD) (2023–00759).