Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery
Fecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal contin...
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| Veröffentlicht in: | Journal of pediatric surgery 2023-01, Vol.58 (1), p.56-63 |
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| creator | Smith, Caitlin A. Kwon, Eustina G. Nicassio, Lauren Glazer, Deb Avansino, Jeffrey Durham, Megan M. Frischer, Jason Calkins, Casey Rentea, Rebecca M. Ralls, Matthew Saadai, Payam Badillo, Andrea Fuller, Megan Wood, Richard J. Rollins, Michael D. Van Leeuwen, Kathleen Reeder, Ron W. Lewis, Katelyn E. Rice-Townsend, Samuel E. |
| description | Fecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation.
A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests.
458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p |
| doi_str_mv | 10.1016/j.jpedsurg.2022.09.024 |
| format | Article |
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A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests.
458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p<0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients.
We observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care.
Level III</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2022.09.024</identifier><identifier>PMID: 36283846</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Child ; Child, Preschool ; Colorectal Surgery ; Constipation - epidemiology ; Constipation - etiology ; Constipation - surgery ; Defecation ; Disparities ; Enema ; Fecal continence ; Fecal Incontinence - epidemiology ; Fecal Incontinence - etiology ; Fecal Incontinence - surgery ; Functional constipation ; Humans ; Idiopathic constipation ; Quality of Life ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Journal of pediatric surgery, 2023-01, Vol.58 (1), p.56-63</ispartof><rights>2022</rights><rights>Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-683e2d34128229372f9ab548871336f7cf847a0e60508939a6d094c2abe000d73</citedby><cites>FETCH-LOGICAL-c368t-683e2d34128229372f9ab548871336f7cf847a0e60508939a6d094c2abe000d73</cites><orcidid>0000-0002-1776-0490 ; 0000-0002-3462-2583 ; 0000-0002-8689-5989 ; 0000-0002-1328-2807 ; 0000-0003-2852-3797 ; 0000-0001-5635-1334</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022346822006194$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36283846$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Caitlin A.</creatorcontrib><creatorcontrib>Kwon, Eustina G.</creatorcontrib><creatorcontrib>Nicassio, Lauren</creatorcontrib><creatorcontrib>Glazer, Deb</creatorcontrib><creatorcontrib>Avansino, Jeffrey</creatorcontrib><creatorcontrib>Durham, Megan M.</creatorcontrib><creatorcontrib>Frischer, Jason</creatorcontrib><creatorcontrib>Calkins, Casey</creatorcontrib><creatorcontrib>Rentea, Rebecca M.</creatorcontrib><creatorcontrib>Ralls, Matthew</creatorcontrib><creatorcontrib>Saadai, Payam</creatorcontrib><creatorcontrib>Badillo, Andrea</creatorcontrib><creatorcontrib>Fuller, Megan</creatorcontrib><creatorcontrib>Wood, Richard J.</creatorcontrib><creatorcontrib>Rollins, Michael D.</creatorcontrib><creatorcontrib>Van Leeuwen, Kathleen</creatorcontrib><creatorcontrib>Reeder, Ron W.</creatorcontrib><creatorcontrib>Lewis, Katelyn E.</creatorcontrib><creatorcontrib>Rice-Townsend, Samuel E.</creatorcontrib><creatorcontrib>Pediatric Colorectal and Pelvic Learning Consortium (PCPLC)</creatorcontrib><title>Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Fecal continence is a concern for many patients with idiopathic constipation and can significantly impact quality of life. It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation.
A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests.
458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p<0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients.
We observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care.
Level III</description><subject>Child</subject><subject>Child, Preschool</subject><subject>Colorectal Surgery</subject><subject>Constipation - epidemiology</subject><subject>Constipation - etiology</subject><subject>Constipation - surgery</subject><subject>Defecation</subject><subject>Disparities</subject><subject>Enema</subject><subject>Fecal continence</subject><subject>Fecal Incontinence - epidemiology</subject><subject>Fecal Incontinence - etiology</subject><subject>Fecal Incontinence - surgery</subject><subject>Functional constipation</subject><subject>Humans</subject><subject>Idiopathic constipation</subject><subject>Quality of Life</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUcFu1DAQtRCILoVfqHzkkjC2s45zA1UUkCpxgbPltSd0Vtkk2A6oX8Bv12ZbrpxszXtvZt48xq4EtAKEfndsjyuGtMUfrQQpWxhakN0zthN7JZo9qP4520FBGtVpc8FepXQEKGUQL9mF0tIo0-kd-3OD3k3cL3OmGWePPFBaXaRMmDjNfHXlN-fEf1O-4xRoKZU78lWSMlV4mXmO6DIG7jKPOGKMpSdVPG8VT3xcIi8Lk8vxr3ZaIvpcWNUCxvvX7MXopoRvHt9L9v3m47frz83t109frj_cNl5pkxttFMqgOiGNlIPq5Ti4w74zphdK6bH3o-l6B6hhD2ZQg9MBhs5Ld8DiPvTqkr09913j8nPDlO2JksdpcjMuW7KylwMo6DtZqPpM9XFJqdiya6STi_dWgK0h2KN9CsHWECwMtoRQhFePM7bDCcM_2dPVC-H9mYDF6S_CaJOnevxA9So2LPS_GQ8pGZ8Q</recordid><startdate>202301</startdate><enddate>202301</enddate><creator>Smith, Caitlin A.</creator><creator>Kwon, Eustina G.</creator><creator>Nicassio, Lauren</creator><creator>Glazer, Deb</creator><creator>Avansino, Jeffrey</creator><creator>Durham, Megan M.</creator><creator>Frischer, Jason</creator><creator>Calkins, Casey</creator><creator>Rentea, Rebecca M.</creator><creator>Ralls, Matthew</creator><creator>Saadai, Payam</creator><creator>Badillo, Andrea</creator><creator>Fuller, Megan</creator><creator>Wood, Richard J.</creator><creator>Rollins, Michael D.</creator><creator>Van Leeuwen, Kathleen</creator><creator>Reeder, Ron W.</creator><creator>Lewis, Katelyn E.</creator><creator>Rice-Townsend, Samuel E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1776-0490</orcidid><orcidid>https://orcid.org/0000-0002-3462-2583</orcidid><orcidid>https://orcid.org/0000-0002-8689-5989</orcidid><orcidid>https://orcid.org/0000-0002-1328-2807</orcidid><orcidid>https://orcid.org/0000-0003-2852-3797</orcidid><orcidid>https://orcid.org/0000-0001-5635-1334</orcidid></search><sort><creationdate>202301</creationdate><title>Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery</title><author>Smith, Caitlin A. ; 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It is unknown whether racial, ethnic, and socioeconomic disparities are seen in fecal continence within the idiopathic constipation population. We aimed to evaluate fecal continence and associated demographic characteristics in children with idiopathic constipation referred for surgical evaluation.
A multicenter retrospective study of children with idiopathic constipation was performed at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). All patients >3y of age with idiopathic constipation diagnosis were included. The primary outcome was fecal continence, categorized as complete (no accidents ever), daytime (no accidents during the day), partial (occasional incontinence day/night), and none (incontinent). We evaluated for associations between fecal continence and race, sex, age, insurance status, and other patient-level factors, employing Kruskal-Wallis and trend tests.
458 patients with idiopathic constipation from 12 sites were included. The median age of diagnosis was 4.1 years. Only 25% of patients referred for surgical evaluation were completely continent. Age at the visit was significantly associated with fecal continence level (p = 0.002). In addition, patients with public and mixed public and private insurance had lower levels of continence (p<0.001). Patients with developmental delay were also more likely to have lower continence levels (p = 0.009) while diagnoses such as anxiety, ADD/ADHD, autism, depression, obsessive-compulsive disorder were not associated. Approximately 30% of patients had an ACE operation (antegrade continence enema) at a median age of 9.2 years at operation. Black patients were significantly less likely to undergo ACE operation (p = 0.016) when compared to white patients.
We observed data that suggest differences in fecal incontinence rates based on payor status. Further investigation is needed to characterize these potential areas of disparate care.
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| ispartof | Journal of pediatric surgery, 2023-01, Vol.58 (1), p.56-63 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Child Child, Preschool Colorectal Surgery Constipation - epidemiology Constipation - etiology Constipation - surgery Defecation Disparities Enema Fecal continence Fecal Incontinence - epidemiology Fecal Incontinence - etiology Fecal Incontinence - surgery Functional constipation Humans Idiopathic constipation Quality of Life Retrospective Studies Treatment Outcome |
| title | Fecal continence disparities in patients with idiopathic constipation treated at referral institutions for pediatric colorectal surgery |
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