Objective To investigate the influencing factors of operative indication of adhesive ileus after abdominal operation. Methods The clinical data of 105 patients with adhesive ileus after abdominal operation admitted to Longhua District People’s Hospital of Shenzhen from June 2020 to December 2022 were retrospectively analyzed. They were divided into operation group (30 cases) and nonoperation group (75 cases) according to whether adhesive ileus surgery was performed.The clinical indicators (history of intestinal adhesion, symptoms of increased or no relief of abdominal pain, severe abdominal distension, fever, ability to reach swollen intestinal lapses, concomitant peritonitis, reduced bowel sound, abdominal effusion and anemia) and the levels of inflammatory factors [white blood cell count (WBC), hypersensitive C-reactive protein (hs-CRP) ]were compared. To analyze the independent risk factors affecting the operative indication of adhesive ileus after abdominal surgery. Results The patients in the operation group with history of intestinal adhesion, aggravation of abdominal pain worsens or does not relieve, palpable swollen intestinal lapses, complicated peritonitis, reduced intestinal sounds and abdominal effusion were higher than those in the non-operation group, and the levels of WBC and hs-CRP were higher than those in the non-operation group (P<0.05). Multiple Logistic regression analysis showed that history of intestinal adhesion, peritonitis, abdominal effusion, and elevated WBC and hs-CRP levels were independent risk factors for operation of adhesive ileus (P<0.05). Conclusion History of intestinal adhesion, peritonitis, abdominal effusion, elevated WBC and hs-CRP levels are independent risk factors for determining surgical indications in patients with postoperative adhesive ileus. Clinical evaluation of patient history and monitoring of inflammatory indicators should be strengthened to determine whether patients with adhesive ileus should undergo surgery as soon as possible.