Retrospective Review of Post-Operative Ileus and/or Bowel Obstruction in Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Stage III-IV after Cytoreductive Surgery

This project involves a retrospective chart review of 25 patients who underwent cytoreductive surgery for ovarian cancer stage IIIb or IV to identify if they developed an ileus, length of stay, and cost. The evaluation of the feasibility of a clinical/surgical fast track protocol at the Huntsman Cancer Hospital. Problem Statement: The incidence of postoperative ileus is 30.3 percent. An ileus can prolong length of stay, delay time for adjuvant chemotherapy, and increase cost of treatment. Objectives:  Identify complication of postoperative ileus and length of stay for ovarian stage IIIb or stage IV cancer who have undergone bowel resection during cytoreductive surgery  Assess feasibility of implementing Clinical/Surgical Fast Track Protocol  Disseminate project findings through submission of a query letter to the Journal of Oncology Nursing and an abstract for presentation at an Oncology Nursing Society sponsored conference. Literature Review: The complication of postoperative ileus is identified in 30 percent of the cancerous and noncancerous abdominal surgeries. In 2011 the estimated cost of postoperative ileus was $5,000- $10,000 per patient. The average length of stay for cytoreductive surgery is 13.9 days. There was no data available in the studies for readmission rates. Opioid use with equivalence of more than 6 mg of hydromorphone per day was identified as causing postoperative ileus. Implementation and Evaluation: The Donabedian theoretical framework guided this project. The Donabedian theoretical framework identifies the setting that structures the care, how the process of care is delivered and coordinated, and the health outcomes. The retrospective chart review included 25 patients with ovarian stage IIIb or IV cancer who underwent cytoreductive surgery that included a bowel resection. The chart review identified 8 patients with an ileus and 17 without an ileus. There was no difference between the two groups when you compared hypertension, type two diabetes mellitus, prior gastrointestinal surgery, narcotic use, prior chemotherapy, number of gastrointestinal anastomosis, operative complications, time to flatus, time to bowel movement, time to regular diet, length of stay, cost, and any readmissions within 30 days. The feasibility of a newly implemented clinical/surgical fast track protocol to minimize the risk of post-operative ileus will be evaluated on the first five women undergoing cytoreductive surgery for ovarian cancer stage IIIb or IV with bowel resection. Resources are in place to evaluate time out of bed, when clear liquid diet, and initiation of solid foods. An abstract has been written to submit for 2015 Oncology Nursing Society conference. Summary: The retrospective chart review results showed there was no difference between ileus and non-ileus. The limitations to the study included: small sample size, can only abstract information from what is documented, and the diagnosis of ileus is subjective. The feasibility of implementing the clinical/surgical fast track protocol is currently being assessed and will continue to evaluate until the five patients have been enrolled and discharged from the hospital.