Surgery for Severe Constipation Shows Little Benefit

Increased colectomy rates for constipation are associated with significant morbidity, raising questions about the true benefit of surgery for slow transit constipation, claims a new study.

Researchers at the University of Pittsburgh Medical Center (UPMC; PA, USA) and Johns Hopkins University (JHU; Baltimore, MD, USA) used data from the Nationwide Inpatient Sample (NIS) (1998–2011) and longitudinal data from the State Inpatient Database (2005–2011), to examine in-hospital morbidity and emergency department (ED) visits or readmissions among patients that underwent colectomies for constipation. In all 2,220 women and 157 men were identified, with nearly 90% of the procedures being elective.

The results showed that across the United States, colectomies for constipation rose from 104 procedures in 1998 (1.2% of annual colectomies) to 311 in 2011 (2.4%). While there were no perioperative deaths, perioperative complications occurred in 42.7% of the patients in the hospital after the surgery, while 28.9% required readmission in the 30 days after discharge. In addition, resource utilization data showed that while the number of ED visits remained unchanged, the number of hospitalizations doubled. The study was published on October 1, 2015, in Alimentary Pharmacology & Therapeutics.

“The longitudinal data demonstrated continuing use of health care resources, dominated by gastrointestinal complaints, and this suggests that the apparent risk of surgery is not offset by improved long-term outcomes,” said lead author Anwar Dudekula, MD, of UPMC. “If indeed health care resource utilization goes up instead of down, it does not indicate true success and improved quality of life, which is the key target in managing functional disease. Thus, it is time to slow down and reassess these guidelines.”

“Stool frequency often increases after the surgery, and while this may well sound like success when we think about one of the defining characteristics, it is only one of many factors. Our study clearly shows that the simple increase in stool frequency is not enough to decrease the need for ongoing and often costly care,” added senior author Klaus Bielefeldt, MD, of JHU. “Perhaps more importantly, the surgical approach comes with significant and concerning side effects that affect nearly half of those operated, meaning the risk is high and the promised benefit may be limited.”

Constipation is common; in the general population rates of constipation vary from 2%–30%. In seniors living in care homes the rate of constipation is even higher, reaching 50%–75%.

Related Links:
University of Pittsburgh Medical Center
Johns Hopkins University