Epidemiology of constipation in critically ill patients and its impact on in-hospital mortality: a retrospective observational study

Yoshida, Takuo; Uchino, Shigehiko; Sasabuchi, Yusuke

doi:10.1007/s00540-022-03050-x

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…However, in a study by Yoshida, et al [10], it was found that mortality did not show an association with increased odds of mortality. The authors carried out a retrospective cohort study involving 1933 ICU patients from 2011-2018.…”

Section: Discussionmentioning

confidence: 90%

Constipation in Hepatocellular Carcinoma Patients: Navigating Clinical Challenges, Hospital Stays and Opioid-Related Risks for Enhanced Patient Care and Outcomes

Javaid*,

DO,

et al. 2023

J Biomed Res Environ Sci

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Background: Constipation can be a significant clinical challenge, impacting patient care and extending hospital stays. We examined the effects of constipation on Hepatocellular carcinoma patients, especially due to increased risk from opioid use in cancer patients, which may affect overall hospital outcomes. Methods: We retrospectively analyzed critically ill patients with hepatocellular carcinoma in the 2019 and 2020 National Inpatient Sample databases. Multivariate regression analysis was applied to adjust for confounding variables and study important outcomes: mortality, length of stay, the total cost of hospitalization, sepsis, acute kidney injury, acute respiratory failure, malnutrition, obesity, weight loss, diarrhea, nausea and vomiting, fatigue, and involvement of palliative care. Results: Of the 38365 patients admitted with Hepatocellular carcinoma, 4685 (12.2%) had a secondary diagnosis of constipation, and 33680 had no constipation. After adjusting for confounding variables, mortality (OR 0.69 95% CI 0.49-0.96, P=0.028) and total hospitalization charges [-13906 USD, 95% CI -22750- (-5063), p = 0.002] were significantly reduced in HCC patients with concurrent constipation, while there was no difference in the length of stay between the two cohorts (0.93, 95% CI 0.37-1.48, p = 0.001. Constipation was associated with decreased odds of obesity (OR 0.78, 95% CI 0.61-0.99, P=0.042) and acute respiratory failure (OR 0.65 95% CI 0.44-0.95, p = 0.029); however, it was coupled with an increased risk of weight loss (OR 1.60 95% CI 1.07-2.40, p= 0.021), nausea/vomiting (OR 2.24 95% CI 1.55-3.24, p < 0.001), fatigue (OR 4.32 95% CI 2.25-8.31, p < 0.001), palliative care involvement (OR 1.88 95% CI 1.55-2.29, p < 0.001), malnutrition (OR 1.72 95% CI 1.46-2.04, p < 0.001) and opioid use disorder (OR 2.50 95% CI 1.62-3.84, p < 0.001). Conclusion: Constipation has been associated with reduced mortality and overall hospitalization costs; however, it is also associated with multiple adverse health events that can contribute to increased morbidity. Additional prospective studies are required to confirm the results of our analysis. Early identification of constipation in high-risk cancer patients could be crucial for predicting morbidity and mortality, as well as aiding in risk stratification to improve outcomes.

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Section: Discussionmentioning

confidence: 90%

Constipation in Hepatocellular Carcinoma Patients: Navigating Clinical Challenges, Hospital Stays and Opioid-Related Risks for Enhanced Patient Care and Outcomes

Javaid*,

DO,

et al. 2023

J Biomed Res Environ Sci

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“…However, the results of logistic regression analysis indicated that only renal dysfunction and respiratory failure were independent risk factors for death in hospital, which is consistent with similar studies. A retrospective observational study involving 1933 patients reported that defecation delay was not associated with in-hospital mortality [Yoshida 2022]. The multivariate analysis of another prospective observational study involving 396 patients also showed that defecation delay was associated with prolonged mechanical ventilation and ICU stays, but not mortality [Launey 2021].…”

Section: Discussionmentioning

confidence: 99%

Effect of Defecation Delay in Patients After Tricuspid Valve Replacement: A Retrospective Study

Chen

Qin

et al. 2023

HSF

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Background: Defecation delay is a common symptom in patients after tricuspid valve replacement (TVR). Previous studies have demonstrated that defecation delay was associated with worse clinical outcomes of critically ill patients. Our study aimed to investigate the incidence and risk factors of defecation delay in patients after TVR and its adverse clinical outcomes. Methods: A retrospective study was conducted in 206 patients undergoing TVR under cardiopulmonary bypass from May 2005 to July 2021. According to the first postoperative defecation time after surgery, patients were divided into the delayed group (>3 days) and control group (≤3 days). Baseline characteristics and preoperative, intraoperative, and postoperative data were collected to investigate the clinical outcomes of defecation delay. Results: Among the 206 patients, 51.9% (107/206) cases were classified into the defecation delay group. Univariate analysis showed that age (P = 0.043), preoperative platelets (PLT) (P < 0.001), cardiopulmonary bypass (CPB) time (P = 0.013), minimum rectal temperature (P = 0.042), and the use of prokinetic drugs (P = 0.015) were significantly different in the two groups. In addition, the perioperative adverse events in the defecation delay group were significantly higher than that of the control group. Logistic regression analysis indicated that the mortality of patients was associated with postoperative renal dysfunction (P = 0.047) and postoperative respiratory failure (P = 0.004) but was not associated with defecation delay (P > 0.05). Conclusion: Patients with defecation delay after TVR were more likely to appear adverse events, however, defecation delay was not associated with mortality after TVR.

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“…A very important barrier to performing epidemiology and treatment studies is the lack of universal diagnostic criteria for constipation 1 , 2 , 7 , 16 , 18 , 26 . International consensus about this item is focused in functional gastrointestinal disorders but there is no consensus about secondary constipation 8 , 9 , 27 .…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical score for early diagnosis of constipation in critically ill children

López,

Sánchez,

Fernández

et al. 2023

Sci Rep

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Constipation affects almost 50% of critically ill pediatric patients and is related to their morbidity and mortality. However, little attention is paid to it and it is diagnosed late and when there are already complications. The objective of this study is to develop and validate a score to identify critically ill children with high risk of constipation 48 h after admission. A single center two phase-study was carried out; the first one (retrospective observational study) to develop the score and the second one to validate it in another prospective observational study. Children between 15 days of life and 18 years old admitted to the PICU for more than 3 days were included. Demographic and clinical data during the first 48 h after PICU admission were collected. Univariate and multivariate analysis and ROC curves were used to develop and validate the score. Data from 145 patients (62.8% boys) with a mean age of 34.9 ± 7.3 months were used to develop the score. Independent factors identified to develop the score were: weight > 7 kg, admission to PICU after surgery, need of vasoconstrictors, doses of fentanyl ≥ 2 mcg/kg/h, and initiation of enteral nutrition later than 48 h after admission. Two cut-off values were identified to set low constipation risk (< 5.7 points) and high constipation risk (> 6.2 points). This score was validated in 124 patients showing a sensibility of 63.2%, specificity of 95.5% and a positive/negative predictive values (P/NPV) of 100% and 82.1% respectively to identify constipated patients. This is the first score to identify high constipation risk in critically ill children. This score is easy to apply, and internal validation has shown a PPV of 100%.

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Epidemiology of constipation in critically ill patients and its impact on in-hospital mortality: a retrospective observational study

Cited by 6 publications

References 27 publications

Constipation in Hepatocellular Carcinoma Patients: Navigating Clinical Challenges, Hospital Stays and Opioid-Related Risks for Enhanced Patient Care and Outcomes

Constipation in Hepatocellular Carcinoma Patients: Navigating Clinical Challenges, Hospital Stays and Opioid-Related Risks for Enhanced Patient Care and Outcomes

Effect of Defecation Delay in Patients After Tricuspid Valve Replacement: A Retrospective Study

Development and validation of a clinical score for early diagnosis of constipation in critically ill children

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