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. 2023 Mar;35(3):e14495.
doi: 10.1111/nmo.14495. Epub 2022 Nov 15.

Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population-based cohort study

Michelle J Gould  1   2 , Margaret A Marcon  1   2 , Geoffrey C Nguyen  3   4   5 , Eric I Benchimol  1   2   5 , Rahim Moineddin  6 , Sarah Swayze  5 , Alexander Kopp  5 , Elyanne M Ratcliffe  7   8 , Neil Merritt  9 , Jacob Davidson  9 , Jacob C Langer  10   11 , Niraj Mistry  2   12 , Armando J Lorenzo  11   13 , Michael Temple  14   15 , Catharine M Walsh  1   2   16
Affiliations

Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population-based cohort study

Michelle J Gould et al. Neurogastroenterol Motil. 2023 Mar.

Abstract

Background: When constipation is refractory to first-line interventions, antegrade enema use may be considered. We aimed to assess the impact of this intervention on healthcare utilization.

Methods: We conducted a population-based, quasi-experimental study with pre-post comparison of the intervention group and a non-equivalent control group using linked clinical and health administrative data from Ontario, Canada. Subjects included children (0-18 years) who underwent antegrade enema initiation from 2007 to 2020 and matched controls (4:1) from the general population. To assess the change in healthcare utilization following antegrade enema initiation, we used negative binomial generalized estimating equations with covariates selected a priori.

Key results: One hundred thirty-eight subjects met eligibility criteria (appendicostomy = 55 (39.9%); cecostomy tube = 83 (60.1%)) and were matched to 550 controls. There was no significant difference in the change in the rate of hospitalizations (rate ratio (RR) 1.05, 95% confidence interval (CI) 0.35-1.75), outpatient visits (RR 1.05, 95% CI 0.91-1.18), or same-day surgical procedures (RR 1.51, 95% CI 0.60-2.43) across cases in 2 years following antegrade enema initiation compared with controls. Cases had an increased rate of emergency department (ED) visits, which was not observed in controls (RR 1.52, 95% CI 1.11-1.79), driven in part by device-related complications.

Conclusions and inferences: Understanding healthcare utilization patterns following antegrade enema initiation allows for effective health system planning and aids medical decision-making. The observed increase in ED visits for device-related complications speaks to the need to improve preventive management to help mitigate emergency care after initiation of antegrade enemas.

Keywords: antegrade enema; appendicostomy; cecostomy; constipation; healthcare utilization; pediatric.

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References

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