P5086 - Fecal Impaction: A Costly and Overlooked Consequence of Constipation - Who’s at Risk and Who Pays the Price?

Sushrut Ingawale, MD, DNB, MBBS¹, Anchit Chauhan, ², Maulinkumar Patel, MBBS, MPH³, Adnan Bhat, MD⁴, Pujitha Vallivedu Chennakesavulu, MD, MBBS⁵, Shefali Mody, MBBS⁶, Vineet R. Chandak, MBBS⁷, Akanksha Togra, MD⁸, Marko Kozyk, MD⁹, Sunny Kumar, MD¹⁰, Akshay Sharma, MBBS¹¹, Charitha Karanam Ramapathy, MD¹², Corinne Caissie, MD¹³, Simran Joshi, MD¹³, Matthew Antony. Manoj, MBBS¹⁴, Hamza Akhtar, MD¹⁵, Suprabhat Giri, DM, MD, MBBS¹⁶, Prabin Sharma, MD¹⁷
1Quinnipiac University - Frank H Netter MD School of Medicine, Bridgeport, CT; 2Maulana Azad Medical College, New Delhi, Delhi, India; 3The University of Texas Health Science Centre at Houston, Philadelphia, PA; 4University of Florida, Gainesville, FL; 5Quinnipiac University Frank H Netter School of Medicine/ St Vincent medical center, Bridgeport, CT; 6SUNY Upstate Medical University Hospital, Syracuse, NY; 7Seth Gordhandas Sundardas Medical College and KEM Hospital, Mumbai, Maharashtra, India; 8Texas Tech University Health Sciences Center, El Paso, El Paso, TX; 9Corewell Health William Beaumont University Hospital, Royal Oak, MI; 10Wright Center for Graduate Medical Education, Scranton, PA; 11Luminis Health Anne Arundel Medical Center, Annapolis, MD; 12UAB Montgomery, Montgomery, AL; 13Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT; 14Beth Israel Deaconess Medical Center, Boston, MA; 15Rochester General Hospital, Rochester, NY; 16Kalinga Institute of Medical Sciences, Bhubaneshwar, Orissa, India; 17Quinnipiac University - St VIncent Medical Center, Bridgeport, CT

Introduction: Fecal impaction (FI) is a serious gastrointestinal complication often from chronic constipation frequently observed in elderly and neurologically vulnerable populations. It can lead to hospitalization, severe complications, and increased healthcare costs. Despite its clinical significance, there is a paucity of nationwide data characterizing FI-related hospitalizations in the United States. This study aims to assess the epidemiology, clinical outcomes, and predictors of morbidity and mortality in FI hospital admissions.

Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample (NIS) from 2016 to 2022. Adult hospitalizations with a primary or secondary diagnosis of FI were identified using ICD-10-CM codes. Survey-weighted analyses were performed to evaluate demographics, complications, discharge dispositions, and outcomes. Multivariable logistic regression was used to identify independent predictors of mortality and major complications, adjusting for age, sex, race, insurance type, and median household income quartile.

Results: A weighted total of 79,790 hospitalizations for FI were identified. The cohort had a mean age of 70.7 years (SD 18.1), with 59.4% female and 66.7% White. Most admissions were covered by Medicare (76.3%). The median hospital length of stay was 3 days (IQR 2–6). Notably, only 45.2% of patients were discharged to home, while 29.3% required skilled nursing or intermediate care, and 21.7% were referred to home health services. In-hospital all-cause mortality was 1.74%. Common complications were urinary retention (14.2%), stercoral colitis (7.6%), rectal ulcers (2.0%), rectal bleeding (2.1%), anal fissures (0.8%), rectal prolapse (0.4%), and intestinal perforation (0.5%). Advanced age was a strong predictor of mortality and non-home discharges; patients aged ≥85 had 8.9 times the odds of in-hospital death compared to those aged 18–49 (p < 0.001). Female sex significantly predicted rectal prolapse (OR 5.31, p< 0.001), while higher income was associated with increased risk of stercoral colitis and anal fissures.

Discussion: FI is an underrecognized condition with significant clinical and resource implications. It primarily affects older adults and is associated with considerable morbidity, including frequent discharge to post-acute care facilities and notable in-hospital mortality. These findings highlight the urgent need for preventative strategies and targeted management to reduce the burden on the healthcare system.

Disclosures:
Sushrut Ingawale indicated no relevant financial relationships.
Anchit Chauhan indicated no relevant financial relationships.
Maulinkumar Patel indicated no relevant financial relationships.
Adnan Bhat indicated no relevant financial relationships.
Pujitha Vallivedu Chennakesavulu indicated no relevant financial relationships.
Shefali Mody indicated no relevant financial relationships.
Vineet Chandak indicated no relevant financial relationships.
Akanksha Togra indicated no relevant financial relationships.
Marko Kozyk indicated no relevant financial relationships.
Sunny Kumar indicated no relevant financial relationships.
Akshay Sharma indicated no relevant financial relationships.
Charitha Karanam Ramapathy indicated no relevant financial relationships.
Corinne Caissie indicated no relevant financial relationships.
Simran Joshi indicated no relevant financial relationships.
Matthew Manoj indicated no relevant financial relationships.
Hamza Akhtar indicated no relevant financial relationships.
Suprabhat Giri indicated no relevant financial relationships.
Prabin Sharma indicated no relevant financial relationships.

Sushrut Ingawale, MD, DNB, MBBS¹, Anchit Chauhan, ², Maulinkumar Patel, MBBS, MPH³, Adnan Bhat, MD⁴, Pujitha Vallivedu Chennakesavulu, MD, MBBS⁵, Shefali Mody, MBBS⁶, Vineet R. Chandak, MBBS⁷, Akanksha Togra, MD⁸, Marko Kozyk, MD⁹, Sunny Kumar, MD¹⁰, Akshay Sharma, MBBS¹¹, Charitha Karanam Ramapathy, MD¹², Corinne Caissie, MD¹³, Simran Joshi, MD¹³, Matthew Antony. Manoj, MBBS¹⁴, Hamza Akhtar, MD¹⁵, Suprabhat Giri, DM, MD, MBBS¹⁶, Prabin Sharma, MD¹⁷. P5086 - Fecal Impaction: A Costly and Overlooked Consequence of Constipation - Who’s at Risk and Who Pays the Price?, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.