Socioeconomic burden of patients hospitalized for fecal impaction: a nationwide retrospective observational study

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BACKGROUND: Fecal impaction (FI) causes serious complications and has a high mortality rate, particularly among older individuals. However, there have been few large-scale studies on FI, and understanding of FI is incomplete. In this study, we aimed to elucidate the characteristics, mortality rates, and healthcare costs of patients hospitalized for FI. METHODS: This retrospective observational study used data from the Japanese national administrative database and included patients hospitalized for FI between April 2016 and March 2023. The characteristics, treatment, outcomes, and healthcare costs of patients were evaluated. The risks for in-hospital mortality were examined using a Fine and Gray model as an exploratory analysis. RESULTS: In total, 30,439 patients were eligible for the study. The median (interquartile range) age was 79 (69-86) years. In total, 4,093 (13.4%) patients were admitted from nursing homes. On admission, 10,734 patients (35.3%) had a history of constipation. The in-hospital mortality rate was 8.4%, increasing with age and reaching 13.5% in patients aged 85 years or older. Total healthcare costs also increased with age, with more than 18 billion JPY spent cumulatively on patients aged 65 years or older across the study period, accounting for 85.9% of the total costs. Total annual healthcare costs exceeded 2700 million JPY and gradually increased over time. In an exploratory analysis, sepsis was the most significant risk factor for mortality, followed by emergency ambulance transportation and admission from a nursing home. CONCLUSIONS: The mortality rate of fecal impaction was 8.4% in our study of a large Japanese national dataset, with the rate approaching 13.5% in those aged 85 years or older. Inpatient healthcare costs increased with age and over time.

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