Patterns and predictors of surgical management in pediatric chronic idiopathic constipation

Chronic idiopathic constipation (CIC) is a common childhood gastrointestinal disorder that substantially affects quality of life and healthcare utilization. Most children are managed successfully with dietary modification, behavioral interventions, and medical therapies. However, many patients experience severe or refractory symptoms that necessitate surgical intervention. We sought to identify patient factors associated with progression to surgical intervention.

A retrospective multi-institutional cohort study was performed of children (<18 years of age) who presented to a pediatric surgeon for chief complaint of CIC between 2017 and 2022. The primary outcome was major surgical intervention for the management of CIC. Patient characteristics, including demographic characteristics and clinical variables, were queried, and multivariable logistic regression was used to assess the association between patient factors and surgical intervention.

A total of 188 patients were included. Forty patients (21.3%) had a major operation for CIC, including antegrade continence enema (ACE) procedures, intestinal resection, and intestinal diversion. Patients who underwent surgery were older at the time of first visit (mean 9.12 vs. 4.64 years; p < 0.001). In multivariable logistic regression, older age at first pediatric surgery visit was independently associated with surgical intervention. Each additional year of age was associated with approximately 30% higher adjusted odds of surgical intervention (adjusted OR 1.29, 95% CI 1.14-1.48; p < 0.001). Sex, race, ethnicity, insurance type, and neurodiversity were not significantly associated with surgery.

Approximately one in five patients referred to a pediatric surgeon for refractory constipation undergo surgical intervention to treat constipation. Older age at presentation was associated with surgical treatment.