Postoperative ileus (POI) is a frequent and often fatal complication of colic surgery. Reliably effective treatments are not available. To determine risk factors and protective factors associated with POI, and to assess the effect of lidocaine IV on short-term survival. One hundred and twenty-six horses that underwent small intestinal colic surgery and that survived for at least 24 hours postoperatively. Retrospective cross-sectional study. The association of 31 pre-, intra-, and postoperative variables with POI and the association of lidocaine treatment with short-term survival were investigated. Associations were evaluated with univariable logistic regression models, followed by multivariable analysis. Significant associations of high heart rate (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.03-1.08), the presence of more than 8 L of reflux at admission (OR = 3.02, 95% CI 1.13-8.02) and the performance of a small intestinal resection (OR = 2.46, 95% CI 1.15-5.27) with an increased probability of POI were demonstrated. Prophylactic lidocaine treatment was significantly associated with a reduced incidence of POI (OR = 0.25, 95% CI 0.11-0.56). Lidocaine treatment was also significantly associated with enhanced short-term survival (OR = 0.30, 95% CI 0.09-0.98). The variables associated with an increased risk of POI can be useful in identifying horses at risk of POI and in providing a more accurate prognosis. The results are supportive for lidocaine IV as an effective prokinetic treatment after small intestinal colic surgery.