A novel approach to prevent post-operative ileus after continuous-flow left ventricular assist device implantation: A retrospective cohort study.
INTRODUCTION
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.
['Badami|Abbasali|A|', 'Fehrenbach Prell|Erika A|EA|', 'Murray|Margaret A|MA|', 'Johnson|Maryl R|MR|', 'Akhter|Shahab A|SA|', 'Lozonschi|Lucian|L|', 'Osaki|Satoru|S|', 'Lushaj|Entela|E|', 'Kohmoto|Takushi|T|']
D000328:Adult D000368:Aged D006348:Cardiac Surgical Procedures D005260:Female D006353:Heart-Assist Devices D006801:Humans D045823:Ileus D015994:Incidence D008297:Male D008875:Middle Aged D011182:Postoperative Care D011183:Postoperative Complications D019919:Prosthesis Implantation D012189:Retrospective Studies D016896:Treatment Outcome
Ileus Ventricular assist device Implantation Gastrointestinal complications