Staller Kyle, Khalili Hamed, Kuo Braden
Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
J Gastroenterol Hepatol. 2015 Nov;30(11):1596-602. doi: 10.1111/jgh.13011.
Elderly, hospitalized patients suffer disproportionately from constipation; however, little data suggest that constipation prophylaxis reduces length of stay (LOS). We performed a retrospective analysis of elderly patients admitted to our hospital with congestive heart failure (CHF) to determine the effects of constipation prophylaxis on LOS.
Patients ≥ 65 years old admitted with the diagnosis of CHF in 2012 were evaluated for home and hospital laxative use on admission. Our primary outcome was LOS. We used linear regression modeling to independently evaluate the impact of constipation prophylaxis on LOS.
Among 618 patients who were eligible for our study, 201 (32.5%) were using laxatives at home, whereas 254 (41.1%) were started on a prophylactic laxative on admission. There was no significant difference in LOS between patients receiving prophylaxis versus those who did not (P = 0.32). Patients with home laxative use had a 1 day longer LOS compared to those without laxative use (6 vs 5, P = 0.03). Among patients with home laxative use, there were 2 days longer LOS in those who were not given constipation prophylaxis on admission (8 vs 6, P = 0.002). After multivariate adjustment, failure to use constipation prophylaxis in patients with home laxative use was the only independent predictor of increased LOS (P = 0.03).
Among elderly patients admitted for CHF exacerbations, failure to use constipation prophylaxis in patients with home laxative use is associated with a significantly longer LOS. Our data suggest that routine use of bowel prophylaxis for elderly CHF patients with preexisting constipation may reduce LOS.
老年住院患者便秘问题尤为突出；然而，几乎没有数据表明预防便秘能缩短住院时间（LOS）。我们对我院收治的老年充血性心力衰竭（CHF）患者进行了一项回顾性分析，以确定预防便秘对住院时间的影响。
对2012年因CHF诊断入院的≥65岁患者入院时在家及住院期间使用泻药的情况进行评估。我们的主要结局指标是住院时间。我们使用线性回归模型独立评估预防便秘对住院时间的影响。
在618例符合我们研究条件的患者中，201例（32.5%）在家中使用泻药，而254例（41.1%）在入院时开始使用预防性泻药。接受预防措施的患者与未接受预防措施的患者在住院时间上无显著差异（P = 0.32）。在家中使用泻药的患者比未使用泻药的患者住院时间长1天（6天对5天，P = 0.03）。在家中使用泻药的患者中，入院时未接受便秘预防措施的患者住院时间长2天（8天对6天，P = 0.002）。经过多变量调整后，在家中使用泻药的患者未使用便秘预防措施是住院时间增加的唯一独立预测因素（P = 0.03）。
在因CHF加重而入院的老年患者中，在家中使用泻药的患者未使用便秘预防措施与住院时间显著延长相关。我们的数据表明，对已有便秘的老年CHF患者常规进行肠道预防可能会缩短住院时间。
