S1205 Fecal Impaction: A Costly and Overlooked Consequence of Constipation—Who’s at Risk and Who Pays the Price?

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 International Classification of Diseases-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% women 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 (odds ratio [OR] 5.31, P < 0.001), while higher income was associated with increased risk of stercoral colitis and anal fissures. Conclusion: 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.