Implementing a bowel program: is a bowel program an effective way of preventing constipation and ileus following elective hip and knee arthroplasty surgery?

Background: The objective of this study was to define an effective bowel protocol for the postoperative total hip and knee arthroplasty patient. Surgery, change in medication, diet, and activity can cause constipation and ileus to occur.

Purpose: To lower the rates of postoperative constipation and ileus by establishing a bowel protocol for hip and knee arthroplasty patients.

Methods: Over a 36-month period this retrospective study examined 484 total hip and 739 total knee arthroplasty patients, and the effect of Bisacodyl Suppository given as needed and intermittently in comparison to a 12-month period when Bisacodyl Suppository was given rectally one time on postoperative Day 1. Reeducation of the staff regarding the importance of administering the suppository began in 2008 and was not fully implemented until January of 2009. In 2009, the new bowel protocol patients and 189 total hip and 250 total knee arthroplasty patients were compared with the 2008 old bowel protocol patients' data.

Results: Hip arthroplasty: Postoperative ileus rate per 1,000 cases for the hip arthroplasty patient decreased from 26.67 in 2008 to 0.0 in 2009 (p = .012; 95% CI [0.0008, 0.052]. The rate of constipation per 1,000 cases decreased from 120.0 in 2008 to 37.04 in 2009 (p = .001; 95% CI [0.024, 0.142]. Knee arthroplasty: Postoperative ileus rate per 1,000 cases for the knee arthroplasty patient was 0.00 in 2008 and 0.0 in 2009. The rate of constipation per 1,000 cases decreased from 89.15 in 2008 to 72.00 in 2009 (p = .24).

Conclusion: Our data supports for this small sample size that a decrease in constipation and ileus can be obtained with the use of an effective bowel protocol for total hip arthroplasty patients. For total knee arthroplasty patients, the data were inconclusive.