Peri-Operative Factors Predicting Prolonged Postoperative Ileus After Emergency Bowel Surgery

Background: Prolonged postoperative ileus (PPOI) is a significant complication following emergency bowel surgery that increases morbidity, hospital stay, and healthcare costs. Limited evidence exists regarding PPOI risk factors in emergency settings, particularly for hollow viscus perforation with peritonitis. Objective: To identify peri-operative factors predicting PPOI following emergency bowel surgery for hollow viscus perforation. Methods: This single-center cross-sectional analytical study was conducted at Medical College and S.S.G. Hospital, Vadodara, between December 2020 and December 2021. Consecutive sampling enrolled 120 patients undergoing emergency bowel surgery for hollow viscus perforation with peritonitis. PPOI was defined using standardized criteria as two or more of nausea/vomiting, inability to tolerate diet, absence of flatus/stool, abdominal distension, or radiological ileus evidence on or after postoperative day 4. Chi-square test assessed associations between categorical variables and PPOI development. Results: PPOI incidence was 15% (18/120 patients). Significant predictors included male sex (21.8% vs 7.1%, p=0.02), age ≥60 years (25% vs 8.3%, p=0.012), smoking history (66.7%, p=0.019), pre-operative anemia (38.9%, p=0.043), hypoalbuminemia (33.3%, p=0.039), operative time ≥240 minutes (33.3%, p=0.039), resection anastomosis (50%, p=0.014), elevated WBC count on postoperative day 4 (72.2%, p=0.027), and anastomotic leakage (22.2%, p=0.01). Conclusion: Multiple pre-operatives, intra-operative, and post-operative factors predict PPOI development. Risk stratification and targeted perioperative optimization strategies are essential for reducing PPOI incidence in resource-constrained emergency settings.