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Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population-based cohort study

Michelle J Gould1,2, Margaret A Marcon1,2, Geoffrey C Nguyen3,4,5

  • 1Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, Toronto, Canada.

Neurogastroenterology and Motility
|November 15, 2022
PubMed

Insights

Antegrade enema initiation for refractory constipation did not significantly alter hospitalizations or outpatient visits. However, it led to more emergency department visits, primarily due to device-related issues.

Area of Science:

  • Pediatric Gastroenterology
  • Health Services Research

Background:

  • Refractory constipation in children often necessitates advanced interventions.
  • Antegrade enema procedures are considered for cases unresponsive to initial treatments.

Purpose of the Study:

  • To evaluate the impact of antegrade enema initiation on healthcare utilization in children.
  • To inform health system planning and clinical decision-making regarding this intervention.

Main Methods:

  • Population-based, quasi-experimental study in Ontario, Canada (2007-2020).
  • Compared children undergoing antegrade enema initiation with matched controls (4:1 ratio).
  • Utilized linked clinical and administrative data with negative binomial generalized estimating equations.

Main Results:

  • No significant differences in hospitalizations, outpatient visits, or same-day surgical procedures between cases and controls within two years.
  • Antegrade enema initiation was associated with a significant increase in emergency department visits (RR 1.52).
  • Device-related complications were a key driver of increased emergency department visits.

Conclusions:

  • Antegrade enemas for refractory constipation do not increase overall hospitalizations or outpatient care.
  • Increased emergency department visits post-intervention are linked to device complications.
  • Improved preventive management strategies are needed to reduce emergency care needs after antegrade enema initiation.
Abstract

Keywords:
antegrade enemaappendicostomycecostomyconstipationhealthcare utilizationpediatric

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