Postoperative Constipation Incidence and Effects of Selected Risk Factors on Constipation Development in Elderly Patients With Hip Fracture

Abstract

Constipation is a common problem in the general population and is particularly prevalent among hospitalized elderly patients with hip fracture due to lack of mobility, medications, and lack of privacy associated with hospitalization. This study aimed to determine the incidence of postoperative constipation and the effects of selected risk factors on constipation development in elderly patients with hip fracture. The study used a descriptive, cross-sectional, and prospective design. Data were collected on the second postoperative day and upon discharge. The study sample included 150 patients. The constipation incidence rate was found to be 77.70%. Of all the patients developing constipation, 87.70% did not have a normal bowel movement even upon discharge. A significant difference was found between constipation development and the total score for constipation risk assessment, postponing defecation, psychological or behavioral barriers to defecation in the hospital environment, preservation of privacy for defecation, and return to normal bowel movement upon discharge. Based on the results, nurses should determine the risk factors for constipation unique to each patient in the postoperative period and conduct appropriate preventive interventions.

Efficacy of Murdoch Bowel Protocol on Constipation among Patients with Hip and Pelvic Surgery

“…. this finding was supported by (Celik B and Bilik Ö 2022) (29) observation which include more than three quarters of patient with hip fracture developed constipation . Also this result agreed with Jing D, Jia L ,2019) (30) who stated that the majority of studied patient had constipation postoperatively in their study .…”

Analysis of the Influencing Factors of Postoperative Constipation in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional and Prospective Study

“…The results of this study also showed that psychological or behavioral barriers to defecation in the hospital environment were a risk factor for postoperative constipation in patients undergoing cardiovascular surgery. It included decreased appetite, decreased mobility, increased stress, and not being adapted to the hospital environment [14]. Defecation requires a private and comfortable environment.…”

“…Since the hospital stay of heart surgery patients generally does not exceed 20 days, therefore we adopted the North America Nursing Diagnosis Association general definition of constipation, which is the state in which an individual experiences or is at high risk of experiencing stasis of the large intestine, resulting in infrequent elimination and/or the inability to achieve a soft bowel movement, a feeling of incomplete rectal emptying, the need for manual evacuation of the rectal region [13]. A re-established defecation pattern was defined as the absence of defecation for 3 days or longer, without the use of any laxative or specific methods to facilitate evacuation [14]. Patients' constipation risk was evaluated from the second postoperative day and upon discharge in this study.…”

“…(2) Preoperative data: prehospital diet and exercise (irregular diet habits, probiotics intake, roughage intake, vegetable intake, make exercise, barthel score), past history (constipation, hemorrhoids, hypertension, diabetes Mellitus, hyperthyroidism, hypothyroidism, stroke, cancer, anemia, hypoproteinemia), drug use (polypharmacy (the types of long-term drug use were ≥5), antidepressant, antihypertensive), New York Heart Association (NYHA) stage, stool routine (latent occult blood test, stool characteristics, color of stool), preoperative constipation, laxatives were used before surgery, gastric tube was used before surgery, restricted to bed before surgery, sleep duration during hospitalization ≥7 h. (3) Related to cardiovascular surgery: preoperative ultrasound (heart rate, ejection fractions (EF) value), surgical classification, surgical incision location, operation time, duration of anesthesia, cardiopulmonary bypass, intraoperative blood loss, intraoperative blood transfusion. (4) Postoperative data: fever in intensive care unit (ICU), ventilator usage time, preoperative ultrasound (EF value), drainage volume within 24 hours after surgery, total volume in postoperative day, postoperative water intake, medication use during hospitalization (hypnotics, cough medicine, sedative, painkillers), reduced food intake, psychological or behavioral barriers to defecation in the hospital environment (contains either item: decreased appetite, decreased mobility, stress, hospital environment, and embarrassment) [14].…”