Constipation due to CF tied to longer, more costly hospital stays
US study looked into patients with and without this complication, general public
In people with cystic fibrosis (CF) — particularly those with pancreatic insufficiency, which affects digestion — constipation typically led to longer hospital stays and higher healthcare costs, a study found.
“Further work is needed to determine management strategies for constipation in hospitalized [people with CF], which may include early identification and treatment,” the researchers, all with a university medical school or hospital in the U.S., wrote.
The study, “Constipation is associated with increased hospital utilization in cystic fibrosis: A national inpatient sample analysis,” was published in Gastro Hep Advances. It drew on records, from 2015 through 2019, in the U.S. National Inpatient Sample database, which collects information on individual hospitalizations — including length, healthcare utilization, and costs — and reasons for hospitalization at patient discharge.
Constipation due to thick mucus affecting digestive track organs
CF is a genetic disease that causes thick mucus to build in the lungs, making it difficult to breathe and airway infections more likely, while mucus buildup in organs like the pancreas and intestines can lead to disease symptoms affecting the digestive track, such as bloating and constipation.
Besides causing discomfort, constipation is associated with a risk of distal intestinal obstruction syndrome (DIOS), a condition where the intestine becomes partially or fully blocked.
According to the scientists, research is lacking into how constipation and its risk factors, such as pancreatic insufficiency and DIOS, affect hospitalizations and digestive problems in people with cystic fibrosis. The team explored the connection between constipation, its symptoms and complications, and the healthcare costs and hospital stay lengths linked to it.
Data covering hospitalized CF adult patients with and without constipation was collected and matched to hospitalized adults in the general population.
Between 2015 and 2019, there were 135,860 hospital discharges for people with cystic fibrosis in the database. On average, their hospital stays lasted 8.8 days, with total charges averaging $104,270. Among the general public, 1.75 million discharges were reported over those years, with average total stays of 4.8 days and total charges of $54,958.
Constipation tied to longer and costlier stays for patients, public at large
Constipation was more common in people with CF than the general population (14% vs. 5.6%). Among CF patients with constipation, 60.6% were female, the group’s average age was 32.5, and 64.4% had pancreatic insufficiency. In comparison, 53.2% of patients without constipation were female, the group’s average age was 33.1, and 52.4% had pancreatic insufficiency.
In people with cystic fibrosis, constipation was linked to a higher likelihood of abdominal pain, nausea, and vomiting. It also associated with an increased risk of DIOS and urinary retention, but a lower likelihood of bowel obstruction and death.
Patients with constipation had longer hospital stays (1.22 additional days on average) and higher hospital charges than patients without this complication. Despite these differences, the number of endoscopic procedures performed was similar between these two groups.
Researchers found that patients with pancreatic insufficiency incurred higher costs ($22,053 more) that other patients, despite similar lengths of a hospital stay. Pancreatic insufficiency occurs when thick mucus builds in the pancreas and the organ fails to make enough enzymes needed to digest food.
In the general population, constipation also linked with longer hospital stays, averaging 2.49 extra days, and higher total hospital costs.
“Our data overwhelmingly [suggest] an association between the presence of constipation and longer hospital length of stay and higher costs in both the general population and [people with CF],” the researchers concluded.
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