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Colectomy for constipation: time trends and impact based on the US Nationwide Inpatient Sample, 1998-2011.

A Dudekula1, S Huftless2, K Bielefeldt1,3

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Colectomy rates for constipation are increasing, but surgery shows significant complications and does not reduce hospital resource use. This raises concerns about the effectiveness of colectomy for slow transit constipation.

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery
  • Health Services Research

Background:

  • Subtotal colectomy is a guideline-recommended treatment for refractory slow transit constipation.
  • Investigating the outcomes of colectomy for constipation is crucial for patient care and resource allocation.

Purpose of the Study:

  • To analyze colectomy rates for constipation in the US from 1998-2011.
  • To evaluate in-hospital morbidity, emergency department (ED) visits, and readmissions following colectomy for constipation.

Main Methods:

  • Utilized the US Nationwide Inpatient Sample (NIS) and State Inpatient Database (SID).
  • Identified colectomies using ICD-9-CM codes (45.8x) and constipation diagnoses (564.x).
  • Captured demographic data, comorbidities, complications, ED visits, and readmissions before and after surgery.

Main Results:

  • Colectomies for constipation increased from 104 (1.2%) in 1998 to 311 (2.4%) in 2011.
  • Perioperative complications occurred in 42.7% of patients; 30-day readmission rate was 28.9%.
  • ED visits remained unchanged, but hospitalizations increased post-colectomy (P=0.003).

Conclusions:

  • Rising colectomy rates for constipation are associated with significant morbidity.
  • Surgery for slow transit constipation does not decrease overall resource utilization.
  • The true benefit of colectomy for slow transit constipation warrants further investigation.