Sa2040 Role of Ethnicity in the Presentation, Evaluation, and Etiology of Severe Constipation

Abstract

INTRODUCTION: Hospitalized patients suffer disproportionately from constipation during their stays, however little data exists to guide clinicians in prophylaxis against in-hospital constipation. We performed a retrospective, cohort analysis of patients admitted to a quaternary care center with congestive heart failure (CHF) to determine the effects of inpatient bowel prophylaxis on inpatient constipation. METHODS: All patients admitted to a quaternary care center with the primary diagnosis of CHF or its equivalent in 2012 (n=802) were evaluated for use of a standing bowel regimen on admission. Constipation was defined as new laxative use after 24 hours of admission, which reflected patient/nursing request or provider judgment that laxation was needed. We chose to examine CHF hospitalizations because predictors of length of stay in this population have been well established in previous studies and constipation tracks with longer stays. We incorporated these previously-validated predictors of length of stay in combination with known and proposed predictors of constipation to create a model for inpatient incidence of constipation. We used this model to examine the effects of in-house constipation prophylaxis on new constipation during admission via logistic regression with estimation of odds ratios and 95% confidence intervals. RESULTS: 802 admissions were examined with 10 admissions excluded because the patients underwent colonoscopy with bowel preparation during their hospitalization. The remaining 792 patients were included to form the final regression model which included demographics (56% male, 85% white, mean age of 75), in-hospital mortality (1%), comorbidities, home medications, admission lab values, bowel prophylaxis on admission, and inpatient medications with the potential to cause constipation. In-hospital constipation occurred in 28.8% of admissions, including 19.0% of patients receiving no bowel prophylaxis and 9.7% of patients receiving prophylaxis. Home laxative use conferred a significantly-increased risk of constipation compared to patients not using laxatives at home (OR 3.6, 95% CI 2.1-6.3) and patients with home laxative use who were placed on inpatient bowel prophylaxis had a significantlydecreased risk of constipation compared to those who were not given prophylaxis on admission (OR 0.24, 95% CI 0.12-0.47). The use of sennosides/docusate combination prophylaxis significantly decreased the risk of constipation (OR 0.32, 95% CI 0.10-0.99) while sennosides and docusate monotherapy had no effect. CONCLUSIONS: Constipation is a common complication of inpatient stays for CHF, but our data suggests the risk is highest for patients taking laxatives at home. The risk of in-hospital constipation could be mitigated by giving sennosides/docusate prophylactic therapy on admission—especially to patients with preexisting constipation.