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Constipation is Associated With Increased Hospital Utilization in Cystic Fibrosis: A National Inpatient Sample
Matt Pelton1, Arvind Bussetty1, Sarah Abdel-Meguid1
1Internal Medicine, Rutgers Robert Wood Johnson, New Brunswick, New Jersey.
Insights
Constipation in patients with cystic fibrosis (CF) significantly increases hospital stays and healthcare costs. This effect is more pronounced in CF patients with pancreatic insufficiency.
Area of Science:
- Gastroenterology
- Pulmonology
- Health Economics
Background:
- Constipation is a common and debilitating symptom for patients with cystic fibrosis (CF).
- Severe constipation can lead to distal intestinal obstruction syndrome in CF patients.
- Understanding the impact of constipation on hospitalization outcomes is crucial for patient care.
Purpose of the Study:
- To characterize the relationship between constipation during hospitalization and its associated symptoms, complications, and healthcare costs in patients with CF.
- To compare hospitalization outcomes for patients with CF and constipation versus those without.
- To analyze the impact of constipation on length of stay and total charges in hospitalized CF patients.
Main Methods:
- Utilized the National Inpatient Sample database for discharges from 2015-2019.
- Matched hospitalized patients with CF to the general population based on comorbidity index, hospitalization severity, and demographics.
- Created cohorts with and without comorbid constipation for comparative analysis, adjusting for relevant covariates.
Main Results:
- Constipation was present in 14.0% of hospitalized patients with CF, compared to 5.6% in the general population.
- Constipation was independently associated with a 1.22-day increase in length of stay and $14,280 in additional charges for CF patients.
- The association of higher costs with constipation was significantly greater in CF patients with pancreatic insufficiency.
Conclusions:
- Comorbid constipation in hospitalized patients with CF is independently linked to increased length of stay and healthcare expenditures.
- The economic burden of constipation is exacerbated in CF patients with pancreatic insufficiency.
- These findings highlight the importance of managing constipation in hospitalized CF patients to mitigate adverse outcomes and reduce costs.
Background And Aims:
Constipation in patients with cystic fibrosis (PwCF) is a debilitating symptom and, in its most severe forms, is associated with distal intestinal obstruction syndrome. This study aims to characterize the relationship between constipation during hospitalization and the symptoms, complications, and associated health-care costs of constipation in the National Inpatient Sample database.
Methods:
National Inpatient Sample was queried for discharges in the general population and PwCF from the years 2015-2019. Using International Classification of Diseases, Tenth Revision codes, hospitalized PwCF were matched with the general population on the Charlson comorbidity index, markers of hospitalization severity, and demographics. Subsequently, both were split into 2 cohorts: one with comorbid constipation and one without. Study outcomes were adjusted for gastrointestinal comorbidities, age, sex, and indication for admission.
Results:
Of 135,860 discharges, constipation was present in 14.0% in PwCF and 5.6% in the general population with average total charges of $104,270 and length of stay (LOS) of 8.8 days. Constipation was independently associated with increased LOS (1.22 days, standard error [SE] 0.21) and total charges ($14,280, SE $12,308) among PwCF, despite undergoing a similar number of endoscopic procedures (-0.02 SE 0.06). These findings were unchanged on subgroup analysis for sex and indication for hospitalization. Subgroup analysis showed a persistent association of higher costs with constipation in those with pancreatic insufficiency but not those with pancreatic sufficiency ($22,053 vs $493) despite a similar LOS.
Conclusion:
Comorbid constipation in hospitalized PwCF was independently associated with increased LOS and costs. The association worsened in those with pancreatic insufficiency.
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