Inpatient use of laxatives during opioid administration in children with sickle cell disease

Constipation is a frequent adverse drug event seen with opioids, the first-line therapy for sickle cell pain crises. Proactive use of laxatives and stool softeners is recommended when opioids are prescribed. Our objective was to generate national estimates of the inpatient use of laxatives during opioid administration in children with sickle cell disease (SCD) and identify associations between individual and hospital-level factors and laxative prescription.

We analyzed data from 29 children's hospitals in the Pediatric Health Information System, extracting patients 0-18 years of age with SCD hospitalized between 7/1/2007 and 6/30/2008. Our main outcome measure was the percentage of opioid-receiving patients who also received a laxative or stool softener.

Six thousand ninety-three total SCD admissions received opioids. Two-thirds (66%) of patients received at least one laxative, and 31% received more than one. The most commonly prescribed constipation medication was polyethylene glycol-electrolyte solution (42.0%), followed by docusate (31.4%) and senna (13.6%). Logistic regression revealed that increasing age was associated with increased use of laxatives, as were length of stay >1 day (OR = 3.12), medical as compared to surgical admissions (OR = 4.16), and discharge diagnosis of constipation (OR = 18.6). Patients were somewhat less likely to receive laxatives in small and large volume hospitals as compared to medium hospitals.

A substantial number of hospitalized patients with SCD receiving opioids do not receive laxatives and there is unexpected variability in the use of these medications. Increased attention needs to be paid to constipation prophylaxis in patients with SCD, particularly in younger patients and post-surgical patients.