Fecal Management Systems: Complications and Compliance With Recommendations: A Retrospective Review

The purpose of this study was to evaluate the complication rates associated with fecal management systems (FMS) and assess compliance with manufacturer guidelines at our institution.

Retrospective review.

Patients with FMS inserted between September 2010 and April 2019 at a tertiary care center located in the Midwestern United States.

Variables collected included demographics, history of liver cirrhosis, anticoagulation, indications for insertion, complications, and diagnostic or therapeutic interventions. Univariate analysis and Fisher exact test were performed to calculate odds ratio of potential predictive factors.

A total of 202 patients were included, with a median age of 63 years. Of these, 3.5% (7 patients) experienced FMS-related complications, all presenting with rectal bleeding; 57% had rectal ulcerations, 71% required transfusions, and 1 patient required operative intervention. Notably, 96% of cases lacked documentation of a digital rectal examination before insertion. The median duration of FMS use was significantly longer in patients with complications (11 days) compared with those without (6 days, P = .05), suggesting that prolonged use may be associated with an increased risk of adverse effects.

Prolonged use of FMS was associated with an increased risk of complications, and overall adherence to recommended guidelines was poor. Implementing structured documentation and assessment protocols may help improve adherence and promote safer use.