Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults

Fakheri, Robert J.; Volpicelli, Frank

doi:10.12788/jhm.3124

Cited by 24 publications

(17 citation statements)

References 25 publications

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“…Bowel regimens with docusate only have not been shown to decrease time to first bowel movement after MIGS (range 3−5 days) [178]. In fact, multiple randomized trials have failed to show any significant efficacy of docusate over placebo [179]. Data from a randomized controlled trial indicate that the addition of senna (8.6 mg daily) may reduce time to first bowel movement by 1 day.…”

Section: The Postoperative Care Phasementioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

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This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.

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Section: The Postoperative Care Phasementioning

confidence: 99%

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Stone¹,

Carey

Fader³

et al. 2021

Journal of Minimally Invasive Gynecology

View full text Add to dashboard Cite

show abstract

“…This preference may be due to docusate's availability without a prescription, its low cost (between 2 and 8 cents per pill), and its safe profile (no adverse reactions to the pill form, no drug interactions, and no hepatic/renal considerations) 17 . However, docusate has been shown to be ineffective compared with placebo in nonsurgical hospitalized patients 18 . Pharmacologic studies suggest that treatment effect takes days to manifest after initiating the medication 19 .…”

Section: Discussionmentioning

confidence: 99%

“…17 However, docusate has been shown to be ineffective compared with placebo in nonsurgical hospitalized patients. 18 Pharmacologic studies suggest that treatment effect takes days to manifest after initiating the medication. 19 As such, docusate would not seem to be an ideal first-line agent for the prevention of postoperative constipation, especially when initiated on the first postoperative day.…”

Section: Prevention Of Postoperative Constipationmentioning

confidence: 99%

Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Woodbury¹,

Coughlin²,

Dubois³

et al. 2023

UROGC

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Importance Constipation is common after pelvic surgery, and studies suggest that surgeons underestimate the negative impact of constipation on patients. Patients undergoing pelvic reconstructive surgery are a unique population requiring special consideration in the prevention and management of constipation. Objective This study aimed to systematically review the literature to identify evidence for prevention of postoperative constipation with medications or fiber in patients undergoing reconstructive pelvic surgery. Study Design A structured literature search was performed of five databases (MEDLINE, Embase, Scopus, Web of Science, the Cochrane Library) from inception to June 2022 for studies of postoperative laxative or fiber use in adult patients undergoing benign pelvic reconstructive surgery. Studies of preoperative bowel preparation and nonsurgical patients were excluded. Data on postoperative constipation were extracted for a qualitative analysis of the literature. Grading of Recommendations Assessment, Development, and Evaluation methodology was applied to assess the quality of evidence. Results We identified 86 references after deduplication. Only 4 studies with a total of 344 patients were eligible for inclusion in the review. The included studies were all randomized controlled trials assessing time to first bowel movement with the earliest published in 2010. Laxative use decreased constipation more than placebo. Multiple-agent laxative use appeared to decrease bothersome constipation more than single-agent docusate. Preoperative fiber did not decrease constipation. By Grading of Recommendations Assessment, Development, and Evaluation criteria, all four studies provide moderate-quality evidence. Conclusions Few studies have investigated laxative regimens in patients after urogynecologic surgery. The available literature is moderate quality and suggests benefit of multiple-agent treatment over docusate only or no treatment.

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“…While this agent is intended to treat constipation, recent studies have demonstrated its lack of efficacy versus placebo. 15,16 This medication represents an opportunity to reduce costs, pill burden, and polypharmacy by removing it from medication lists or utilizing the more effective laxatives that are available.…”

Section: Discussionmentioning

confidence: 99%

Nonprescription Medication Use in Hospice Patients

Baltz

Gressler

Costantino

et al. 2019

Am J Hosp Palliat Care

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Objective: Patients admitted to hospice are more vulnerable to age-related physiologic changes, polypharmacy, and inappropriate medication use and monitoring. The objective of this study was to characterize the utilization of nonprescription medications in a hospice population. Methods: This was a retrospective study designed to characterize nonprescription or over-the-counter medication use in hospice patients. Data for this study were provided by Seasons Hospice & Palliative Care, a national hospice organization with licenses to operate in 19 states and collected from January 1 to December 31, 2016. The most frequently utilized nonprescription medications, therapeutic classes, and the frequency of patients with at least 1 claim within a therapeutic class were summarized. Results: The final study population included 62 639 orders representing 15 164 patients. The average age was 79.31 years with a standard deviation of 13.31 years. The average length of stay was 26.80 days with a standard deviation of 44.14 days. The top 5 most common medications were as follows: acetaminophen (25.15%), bisacodyl (21.69%), senna (8.35%), omeprazole (4.51%), and docusate (4.46%). Approximately 13 714 (29.67%) of patients were exposed to analgesics, 13 469 (29.14%) to laxatives, and 3535 (7.65%) to antacids or antigas medications. Conclusion: This study highlights numerous opportunities for improvement in the use of nonprescription medications among hospice patients. Reducing the use of nonprescription medications that are ineffective or produce unwanted side effects can contribute to improving the quality of care that patients receive.

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Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults

Cited by 24 publications

References 25 publications

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper

Prevention of Postoperative Constipation in Urogynecology Patients: A Systematic Review

Nonprescription Medication Use in Hospice Patients

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