Osteopathic Manipulative Treatment Protocol for Postoperative Care Following Abdominal Surgery: A Quality Improvement Project

Sep 30, 2026

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Postoperative ileus (POI) commonly prolongs hospital stays and increases resource use after abdominal surgery, while treatment largely remains supportive. A quality improvement initiative implemented a standardized osteopathic manipulative treatment (OMT) protocol at Mayo Clinic Health System Hospital in Mankato to accelerate early bowel recovery. A single-center mixed retrospective-prospective project compared 33 treated patients with 55 retrospective controls, measuring length of stay and related outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Introduction

How to cite this article

Review began 11/05/2025 Review ended 11/19/2025 Published 12/08/2025 © Copyright 2025 Genewick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98685 Open Access Original Article Osteopathic Manipulative Treatment Protocol for Postoperative Care Following Abdominal Surgery: A Quality Improvement Project Joanne Genewick 1 , Alfred Amendolara 2, 3, Sara Robinson 4, Michelle McDonough 4, Marisela Loera 4 , Stephen K. Stacey 5 1. Family Medicine, Mayo Clinic Health System, Mankato, USA 2. Neurology, St. Luke 's University Health Network, Bethlehem, USA 3. Biomedical Sciences, Noorda College of Osteopathic Medicine, Provo, USA 4. Family Medicine, Mayo Clinic Health System, Mankota, USA 5. Family Medicine, Mayo Clinic Health System, La Crosse, USA Corresponding author: Alfred Amendolara, [do25.abamendolara@noordacom.org](do25.abamendolara@noordacom.org) Abstract Background Postoperative ileus (POI) is a common condition that increases length of stay (LOS) and resource utilization. However, treatment consists primarily of supportive care. No workflow addressing measures to promote early bowel function recovery following abdominal surgery was in place at Mayo Clinic Health System Hospital in Mankato. Osteopathic manipulative treatment (OMT) may provide a cost-effective and low-risk option for reducing LOS of surgical patients. The primary aim of this quality improvement project was to decrease LOS of patients at risk for POI following abdominal surgery by implementing a standardized OMT protocol at Mayo Clinic Health System Hospital in Mankato, MN. Methods This was a single-center, non-randomized, mixed retrospective-prospective quality improvement project taking place from 2021-2023 taking place at Mayo Clinic Health System Hospital in Mankato, MN. Surgical patients admitted for abdominal surgery with an expected length of stay greater than a day were invited to participate and receive treatment with a pre-defined OMT treatment protocol including seven techniques. Patients under 18 were excluded. A total of 33 patients were enrolled over two cycles, February 1, 2022-April 30, 2022, and February 1, 2023-April 30, 2023. A baseline comparison group of 55 patients was retrospectively compiled following these same criteria over a period from January 1, 2021, to April 30, 2021. The primary outcome measured was LOS in days. Secondary outcomes were time to first bowel movement, time to first flatus, 30-day readmission rate, and postoperative LOS. Results The baseline group had a median LOS of 7.0 days and while the OMT group had a median LOS of 6 .0 days resulting in a non-significant median difference of-1 days [Hodges-Lehmann estimator: -1, 95% CI (-3 .0, 0.00), p=0 . 128] as well as an effect size r= -0.19 [95% CI (-0 .44, 0.03)] favoring the OMT group. No significant difference was found in secondary outcomes. Subgroup analysis revealed a significant reduction in median LOS [Hodges-Lehmann estimator: -2 .99, 95% CI (-5 .00, -1.00), p=0 .011, r= -0.38] and postoperative LOS [Hodges-Lehmann estimator: -2 .00, 95% CI (-3 .99, 0.00), p=0 .028, r= -0.33] in patients who underwent open surgical procedures. Conclusions In this quality improvement (QI) initiative, the incorporation of a standardized OMT protocol was associated with a non-significant reduction in LOS and postoperative LOS. However, patients undergoing open surgical procedures did show a significant reduction in both LOS and postoperative LOS. These findings suggest the feasibility of this protocol ; however, due to the limitations of the study, they warrant further investigation in properly powered, randomized-controlled trials. Categories: Osteopathic Medicine, Integrative/Complementary Medicine Keywords: general

FAQs

What problem does the study address after abdominal surgery?

The study targets postoperative ileus (POI), a temporary cessation of intestinal motility that increases length of stay and healthcare costs.

How was the OMT intervention implemented in this quality improvement project?

Patients at risk for POI received a pre-defined osteopathic manipulative treatment protocol using seven techniques, as part of a standardized workflow.

What outcomes were evaluated to determine the protocol’s impact?

The primary outcome was length of stay in days. Secondary outcomes included time to first bowel movement and flatus, 30-day readmission rate, and postoperative length of stay.

Sep 30, 2026

Uploaded by Rizky