Constipation-Related Healthcare Utilization in Children Before and After Hospitalization for Constipation

Background: While constipation is largely addressed in the outpatient setting, children are sometimes hospitalized for this issue.  The impact of hospitalization for constipation on subsequent constipation-related healthcare utilization is poorly understood.

Methods: First admissions for constipation in 2010-2011 were identified in the Truven Marketscan Medicaid Database, which includes children enrolled in Medicaid in multiple de-identified states.  Admissions were identified using ICD-9 codes for constipation (564.0), intestinal impaction (560.3), or encopresis (307.7) as the primary diagnosis code or as a secondary diagnosis code with a non-specific abdominal diagnosis as the primary code.  The number of outpatient visits and spending for the same ICD-9 codes were identified in the 12 months before and after the index admission.  We also examined spending for inpatient constipation treatment and re-hospitalization for constipation within 12 months of the index hospitalization.

Results: There were 780 index hospitalizations for constipation among children in the database in 2010-2011.  The median number of outpatient constipation visits was 1 (IQR [0,3]) in the 12 months before and 2 (IQR [0,4]) in the 12 months after admission (p=0.001); the mean number of visits was 2.17 before and 2.48 after admission.  Median outpatient spending for constipation was $110 (IQR [0,429]) before and $132 (IQR [0,431]) after admission (p=0.232); mean outpatient spending was $516 before and $508 after admission.  Median and mean spending for the index constipation admission were $5,295 (IQR [2756,8267]) and $7,565 respectively.  Seventy-eight patients (10%) were re-hospitalized for constipation treatment within 12 months of the index admission.

Conclusions: Constipation related healthcare utilization did not decrease after hospitalization for constipation.  Given the large differential expense of inpatient vs. outpatient treatment and no decrease in subsequent utilization, further study is needed to identify if there is clinical benefit to hospitalization for constipation.