OBJECTIVES: To determine the relationship between postsurgical opioid use through morphine equivalent dose (MED) and ileus was assessed in patients undergoing common GI surgeries, and the impact of ileus on length of stay (LOS), total visit cost, and 30-day readmissions. METHODS: The Premier database was queried to identify adult inpatients discharged between 2008 and 2010 who received postsurgical opioids following open colectomy, laparoscopic colectomy or cholecystectomy. Ileus was identified using ICD-9 diagnosis codes and postsurgical (MED) was calculated.  Descriptive statistics including the outcomes of LOS, total visit cost, and 30-day readmission were obtained. For comparing patients with and without ileus, t-tests for continuous variables and chi-squared tests for categorical variables were used (alpha = 0.05). RESULTS: There were 138,068 patients, average age of 56.8 (SD 18.5) that met the study criteria. Overall, 10.3% of patients had an ileus, ranging from 3.2% in laparoscopic cholecystectomy to 20.6% in open colectomy.  The unadjusted mean LOS (+7.3 days p<0.0001), total visit cost (+$15,928 p<0.0001), and readmissions (+5.9% p<0.0001) were higher for patients with ileus compared to those without ileus.  Of note, the total visit costs were 3 times higher among patients experiencing an ileus after laparoscopic cholecystectomies compared to 2 times greater for other GI procedures complicated by ileus, than patients without ileus. Patients with higher (above median) MED compared to lower (below median) MED had a 2 fold greater odds of ileus (OR 2.0 95% CI 1.92 – 2.06; p <0.0001). CONCLUSIONS: Occurrence of ileus significantly increased the total cost across all GI surgeries even in surgeries where the incidence of ileus is less common. In this study, higher dosages of opioids are associated with the incidence of ileus; more research is needed to determine whether strategies to decrease opioid use improves outcomes and reduces ileus.