By Any Other Name: Bowel Dysfunction After Proctectomy for Cancer and Its Predictive Factors in Administrative Databases

IF 1.8 3区 医学 Q2 SURGERY Journal of Surgical Research Pub Date : 2024-10-16 DOI:10.1016/j.jss.2024.09.027
Ira L. Leeds MD, MBA, ScM , Nathan A. Coppersmith MD , Miranda S. Moore MPH , Ahmad Saleh BS , Kingsley Cruickshank BS , Haddon Pantel MD , Vikram Reddy MD, PhD , Anne K. Mongiu MD, PhD
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Abstract

Introduction

Diagnosis, outcomes, and costs of care associated with bowel dysfunction after proctectomy for cancer remain underexplored in population-based studies. The lack of administrative coding for bowel dysfunction or low anterior resection syndrome has historically limited secondary data set outcomes analysis. The purpose of this study was to identify a bowel dysfunction phenotype in administrative claims data and characterize its prevalence, predictive factors, and costs.

Materials and methods

Patients were identified with employer-sponsored commercial insurance (MarketScan research databases) undergoing proctectomy for cancer for a retrospective cohort study. Bowel dysfunction was defined as any patient with diagnostic codes for diarrhea, constipation, incontinence, pelvic floor diagnostic testing, or rehabilitative procedures that occurred in the 18 mo to follow surgery. We performed Poisson regression to identify statistically significant covariates of bowel dysfunction occurrence following low anterior resection. A secondary comparative analysis was also performed of total costs of healthcare utilization following gastrointestinal continuity.

Results

6426 proctectomy patients were identified, out of which 2131 had surgery for cancer. 847 patients undergoing proctectomy for cancer (39.7%) experienced bowel dysfunction during 18 mo of follow-up. The most common diagnoses were constipation (53.5%) and diarrhea (40.3%). Diagnostic procedures and rehabilitative procedures were performed in only 29.8% of those with symptoms. Neoadjuvant chemotherapy administration with radiation (incidence rate ratio = 1.23, 95% CI: 1.01-1.51) and without (incidence rate ratio = 1.20, 95% CI: 1.01-1.42) remained associated with postoperative bowel dysfunction when controlling for other factors. Chemoradiation therapy alone was not associated with bowel dysfunction. The median total follow-up costs with bowel dysfunction were $30,769 greater (P < 0.001).

Conclusions

More than one-third of patients have symptomatic bowel dysfunction within 18 mo after restored continuity, with multiagent chemotherapy being the strongest independent predictor. Bowel dysfunction is associated with more than twice healthcare costs postop.
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任何其他名称:行政数据库中的癌症直肠切除术后肠道功能障碍及其预测因素
导言:在基于人群的研究中,与癌症直肠切除术后肠道功能障碍相关的诊断、结果和护理成本仍未得到充分探讨。由于缺乏肠功能障碍或低位前切除综合征的行政编码,二级数据集的结果分析一直受到限制。本研究的目的是在行政索赔数据中识别肠道功能障碍表型,并描述其患病率、预测因素和成本。材料和方法通过雇主赞助的商业保险(MarketScan 研究数据库)识别因癌症接受直肠切除术的患者,进行回顾性队列研究。肠道功能障碍的定义是在手术后 18 个月内出现腹泻、便秘、失禁、盆底诊断测试或康复程序等诊断代码的任何患者。我们进行了泊松回归,以确定低位前路切除术后发生肠道功能障碍的具有统计学意义的协变量。我们还对胃肠道连续性手术后的总医疗费用进行了二次比较分析。847名因癌症接受直肠切除术的患者(39.7%)在18个月的随访期间出现了肠道功能障碍。最常见的诊断为便秘(53.5%)和腹泻(40.3%)。只有 29.8% 的症状患者接受了诊断和康复治疗。在控制其他因素的情况下,新辅助化疗与放疗(发生率比=1.23,95% CI:1.01-1.51)和非新辅助化疗(发生率比=1.20,95% CI:1.01-1.42)仍与术后肠道功能紊乱有关。单纯化放疗与肠功能紊乱无关。结论超过三分之一的患者在恢复连续性后18个月内出现症状性肠道功能障碍,其中多药化疗是最强的独立预测因素。肠道功能障碍与术后两倍以上的医疗费用相关。
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来源期刊
CiteScore
3.90
自引率
4.50%
发文量
627
审稿时长
138 days
期刊介绍: The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.
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