A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs

• Published in: Journal of pediatric surgery Vol. 53; no. 9; pp. 1737 - 1741
• Main Authors: Reck-Burneo, Carlos A., Vilanova-Sanchez, Alejandra, Gasior, Alessandra C., Dingemans, Alexander J.M., Lane, Victoria A., Dyckes, Robert, Nash, Onnalisa, Weaver, Laura, Maloof, Tassiana, Wood, Richard J., Zobell, Sarah, Rollins, Michael D., Levitt, Marc A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: Bowel management program; Child; Constipation - economics; Constipation - therapy; Disease Management; Emergency Service, Hospital - economics; Emergency Service, Hospital - statistics & numerical data; Follow-Up Studies; Functional constipation; Health care costs; Health Care Costs - statistics & numerical data; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Treatment Outcome; United States; Functional constipation; Health care costs; Bowel management program
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2018.03.020

Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2. ED visits, hospital admissions, and constipation-related morbidities (abdominal pain, fecal impaction, urinary retention, urinary tract infections) 12 months before and 12 months after completion of the BMP were recorded. One hundred eighty-four patients were included (center 1 = 96, center 2 = 88). Sixty-three (34.2%) patients had at least one unplanned visit to the ED before treatment. ED visits decreased to 23 (12.5%) or by 64% (p < 0.0005). Unplanned hospital admissions decreased from 65 to 28, i.e., a 56.9% reduction (p < 0.0005). In children with severe functional constipation, a structured BMP decreases unplanned visits to the ED, hospital admissions, and costs for constipation-related health care. 3