Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation

Abstract

We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

Things We Do for No Reason™: Routinely hospitalizing children with fecal impaction for inpatient cleanouts

“…However, as effective as inpatient cleanouts may be acute, 10% of children are readmitted for constipation within 12 months. 10 This is similar to rates observed for asthma, 11 an ambulatory care-sensitive condition in which high-quality outpatient care is believed to reduce hospitalizations. 12 Unnecessary testing and treatment are other sources of waste.…”

“…Hospitalization may represent a reasonable investment if it effectively addressed the underlying condition and reduced future utilization. However, as effective as inpatient cleanouts may be acute, 10% of children are readmitted for constipation within 12 months 10 . This is similar to rates observed for asthma, 11 an ambulatory care‐sensitive condition in which high‐quality outpatient care is believed to reduce hospitalizations 12 …”

A Pilot Study of Non-invasive Sacral Nerve Stimulation in Treatment of Constipation in Childhood and Adolescence

“…Although obesity, with its effects, is perceived as a public health problem, constipation is sometimes trivialized. Affected patients have a high level of psychological distress (4), leading to a reduced quality of life (5,6), which both is resulting in increasing health-related costs (7).…”

Constipation-Related Emergency Department Use, and Associated Office Visits and Payments Among Commercially Insured Children

“…A study by Stephens et al showed in a publicly insured population the median spending for 1 constipation admission was 50 times the median spending for 12 months of outpatient constipation visits. 19 A visit in the 30 days before the ED visit represents a potential opportunity to manage this problem before abdominal pain or stool impaction occurs.…”