Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population‐based cohort study

Abstract

Background When constipation is refractory to first‐line interventions, antegrade enema use may be considered. We aimed to assess the impact of this intervention on healthcare utilization. Methods We conducted a population‐based, quasi‐experimental study with pre–post comparison of the intervention group and a non‐equivalent control group using linked clinical and health administrative data from Ontario, Canada. Subjects included children (0–18 years) who underwent antegrade enema initiation from 2007 to 2020 and matched controls (4:1) from the general population. To assess the change in healthcare utilization following antegrade enema initiation, we used negative binomial generalized estimating equations with covariates selected a priori. Key Results One hundred thirty‐eight subjects met eligibility criteria (appendicostomy = 55 (39.9%); cecostomy tube = 83 (60.1%)) and were matched to 550 controls. There was no significant difference in the change in the rate of hospitalizations (rate ratio (RR) 1.05, 95% confidence interval (CI) 0.35–1.75), outpatient visits (RR 1.05, 95% CI 0.91–1.18), or same‐day surgical procedures (RR 1.51, 95% CI 0.60–2.43) across cases in 2 years following antegrade enema initiation compared with controls. Cases had an increased rate of emergency department (ED) visits, which was not observed in controls (RR 1.52, 95% CI 1.11–1.79), driven in part by device‐related complications. Conclusions and Inferences Understanding healthcare utilization patterns following antegrade enema initiation allows for effective health system planning and aids medical decision‐making. The observed increase in ED visits for device‐related complications speaks to the need to improve preventive management to help mitigate emergency care after initiation of antegrade enemas.

Psychosocial factors impacting antegrade continence enema outcomes in pediatric patients

“…Medical risks include stoma break down, stomal stenosis, pain with enema, increased risk of infection, and potential surgical revisions 18–20 . Relatedly, patients who undergo ACE have demonstrated increased emergency department visits compared to controls 21 . Additionally, the regimen following surgery requires daily flushes and toilet sits for extended periods of time (e.g., 45 min) which may be taxing on families and may also be difficult for children and adolescents to complete.…”

“…[18][19][20] Relatedly, patients who undergo ACE have demonstrated increased emergency department visits compared to controls. 21 Additionally, the regimen following surgery requires daily flushes and toilet sits for extended periods of time (e.g., 45 min) which may be taxing on families and may also be difficult for children and adolescents to complete. One study noted that several families reported their child resented the time that was required to complete daily flushes.…”