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Researchers question benefit of colectomy for refractory slow transit constipation
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While the rate of colectomies performed for patients with refractory slow transit constipation are on the rise, the procedure is associated with significant risks and may have limited benefits, according to recent study data.
“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,” Klaus Bielefeldt, MD, PhD, from the University of Pittsburgh Medical Center and Johns Hopkins University, said in a press release. “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.”
Because the frequency and benefit of colectomy for patients with severe constipation was unknown, Bielefeldt and colleagues used the Nationwide Inpatient Sample (1998-2011) and longitudinal data from state databases for California and Florida (2005-2011) to evaluate trends in procedural frequency, perioperative complications and health care utilization.
They found that constipation was the primary indication for 2,377 of the 143,909 colectomies performed nationally during the study period (17 per 1,000; 93.4% women; 66.4% whites; 88.5% elective; mean age, 45 years).
The national rate of colectomy for constipation doubled from 12 per 1,000 colectomies in 1998 to 24 per 1,000 in 2011 (P < .01). Open surgery was performed in 78.7% of cases compared with 21.3% with a laparoscopic approach.
No perioperative deaths occurred, but 42.7% of the procedures were associated with complications, including nausea, ileus, obstructions, postoperative fever, electrolyte abnormality and bile duct injuries.
The 181 patients identified in the state databases who underwent colectomy for constipation had comparable rates of perioperative complications and a 28.9% readmission rate within the first 30 days after hospitalization. Health care resource utilization was tracked in 166 of these patients for a median duration of 630 (range, 0-2,386) days before colectomy and 463 (range, 0-2,204) days after colectomy. Emergency department visits were unchanged (median, 2 vs. 2), but hospitalizations increased (median, 1 vs. 2; P = .003). Multivariate analysis showed no statistically significant association between colectomy and health care utilization before and after the procedure.
“Overall, our data argue for caution and a critical reassessment of operative approaches to manage chronic constipation,” the researchers concluded, adding that currently accepted guidelines should be updated. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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