Variation in surgical management of neurogenic bowel among centers participating in National Spina Bifida Patient Registry.

Published

Journal Article

PURPOSE: Optimal management of neurogenic bowel in patients with spina bifida (SB) remains controversial. Surgical interventions may be utilized to treat constipation and provide fecal continence, but their use may vary among SB treatment centers. METHODS: We queried the National Spina Bifida Patient Registry (NSBPR) to identify patients who underwent surgical interventions for neurogenic bowel. We abstracted demographic characteristics, SB type, functional level, concurrent bladder surgery, mobility, and NSBPR clinics to determine whether any of these factors were associated with interventions for management of neurogenic bowel. Multivariable logistic regression with adjustment for selection bias was performed. RESULTS: We identified 5,528 patients with SB enrolled in the 2009-14 NSBPR. Of these, 1,088 (19.7%) underwent procedures for neurogenic bowel, including 957 (17.3%) ACE/cecostomy tube and 155 (2.8%) ileostomy/colostomy patients. Procedures were more likely in patients who were older, white, non-ambulatory, with higher-level lesion, with myelomeningocele lesion, with private health insurance (all p< 0.001), and female (p= 0.006). On multivariable analysis, NSBPR clinic, older age (both p< 0.001), race (p= 0.002), mobility status (p= 0.011), higher lesion level (p< 0.001), private insurance (p= 0.002) and female sex (p= 0.015) were associated with increased odds of surgery. CONCLUSIONS: There is significant variation in rates of procedures to manage neurogenic bowel among NSBPR clinics. In addition to SB-related factors such as mobility status and lesion type/level, non-SB-related factors such as patient age, sex, race and treating center are also associated with the likelihood of undergoing neurogenic bowel intervention.

Full Text

Duke Authors

Cited Authors

  • Routh, JC; Joseph, DB; Liu, T; Schechter, MS; Thibadeau, JK; Chad Wallis, M; Ward, EA; Wiener, JS

Published Date

  • December 11, 2017

Published In

Volume / Issue

  • 10 / 3-4

Start / End Page

  • 303 - 312

PubMed ID

  • 29125521

Pubmed Central ID

  • 29125521

Electronic International Standard Serial Number (EISSN)

  • 1875-8894

Digital Object Identifier (DOI)

  • 10.3233/PRM-170460

Language

  • eng

Conference Location

  • Netherlands