Integrated fixed-film activated sludge (IFAS) is a hybrid wastewater treatment process that combines suspended and attached growth. The current review provides an overview of the effect of operating parameters on the performance of IFAS and their implications for wastewater treatment. The operating parameters examined include hydraulic retention time (HRT), solids retention time (SRT), dissolved oxygen (DO) levels, temperature, nutrient loading rates, and aeration. Proper control and optimization of these parameters significantly enhance the treatment efficiency and pollutant removal. Longer HRT and appropriate SRT contribute to improved organic matter and nutrient removal. DO levels promote the growth of aerobic microorganisms, leading to enhanced organic matter degradation. Temperature influences microbial activity and enzymatic reactions, impacting treatment efficiency. Nutrient loading rates must be carefully managed to avoid system overload or inhibition. Effective aeration ensures uniform distribution of wastewater and biofilm carriers, optimizing contact between microorganisms and pollutants. IFAS has been used in water reuse applications, providing a sustainable and reliable water source for non-potable uses. Overall, IFAS has proven to be an effective and efficient treatment process that can provide high-quality effluent suitable for discharge or reuse. Understanding the effects of these operating parameters helps to optimize the design and operation for efficient wastewater treatment. Further research is needed to explore the interactions between different parameters, evaluate their impact under varying wastewater characteristics, and develop advanced control strategies for improved performance and sustainability.