title: Constipation prophylaxis reduces length of stay in elderly hospitalized heart failure patients with home laxative use.
abstract: OBJECTIVE
  Elderly, hospitalized patients suffer disproportionately from constipation; however, little data suggest that constipation prophylaxis reduces length of stay (LOS). We performed a retrospective analysis of elderly patients admitted to our hospital with congestive heart failure (CHF) to determine the effects of constipation prophylaxis on LOS.
  
  
  METHODS
  Patients ≥ 65 years old admitted with the diagnosis of CHF in 2012 were evaluated for home and hospital laxative use on admission. Our primary outcome was LOS. We used linear regression modeling to independently evaluate the impact of constipation prophylaxis on LOS.
  
  
  RESULTS
  Among 618 patients who were eligible for our study, 201 (32.5%) were using laxatives at home, whereas 254 (41.1%) were started on a prophylactic laxative on admission. There was no significant difference in LOS between patients receiving prophylaxis versus those who did not (P = 0.32). Patients with home laxative use had a 1 day longer LOS compared to those without laxative use (6 vs 5, P = 0.03). Among patients with home laxative use, there were 2 days longer LOS in those who were not given constipation prophylaxis on admission (8 vs 6, P = 0.002). After multivariate adjustment, failure to use constipation prophylaxis in patients with home laxative use was the only independent predictor of increased LOS (P = 0.03).
  
  
  CONCLUSIONS
  Among elderly patients admitted for CHF exacerbations, failure to use constipation prophylaxis in patients with home laxative use is associated with a significantly longer LOS. Our data suggest that routine use of bowel prophylaxis for elderly CHF patients with preexisting constipation may reduce LOS.
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Staller
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Khalili
authors.affiliation: Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Braden
authors.initials: B
authors.lastname: Kuo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003248:Constipation / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D006333:Heart Failure; D006760:Hospitalization; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies
chemical_list: D054368:Laxatives
keywords: bowel protocols; congestive heart failure; constipation; hospitalization; laxatives