By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative...

Area of Science:

• Colorectal surgery outcomes
• Gastrointestinal oncology
• Health services research

Background:

• Bowel dysfunction after proctectomy for cancer is poorly understood in population studies.
• Lack of specific administrative codes hinders analysis of low anterior resection syndrome.
• This study aimed to define and analyze bowel dysfunction phenotypes in claims data.

Purpose of the Study:

• Identify a bowel dysfunction phenotype in administrative claims data.
• Characterize the prevalence and predictive factors of bowel dysfunction post-proctectomy.
• Assess the associated healthcare costs of bowel dysfunction.

Main Methods:

• Retrospective cohort study using employer-sponsored insurance claims (MarketScan).
• Defined bowel dysfunction by diagnostic codes for diarrhea, constipation, or incontinence within 18 months post-surgery.
• Used Poisson regression to identify predictors and compared healthcare costs.

Main Results:

• 39.7% of 2131 cancer proctectomy patients experienced bowel dysfunction within 18 months.
• Constipation (53.5%) and diarrhea (40.3%) were most common; diagnostic/rehabilitative procedures were underutilized (29.8%).
• Neoadjuvant chemotherapy (with or without radiation) predicted dysfunction; median costs were $30,769 higher for affected patients (P < 0.001).

Conclusions:

• Over one-third of patients develop symptomatic bowel dysfunction within 18 months of proctectomy.
• Multiagent chemotherapy is the strongest predictor of postoperative bowel dysfunction.
• Bowel dysfunction more than doubles postoperative healthcare costs.