Abstract
INTRODUCTION:
Constipation is common in older individuals and becomes prevalent in elderly inpatients. Those recovering from a hip fracture experience worsening constipation due to poor mobility, changes in diet and hydration, general anaesthesia and opioid use. This study explores the feasibility of the pelvic radiographs (PXR) already available in this population in assessing the severity of constipation in order to guide post-operative bowel management. AIM: To evaluate the effectiveness of diagnosis and management of constipation based on PXR findings of elderly patients presenting with hip fracture.
METHODS:
Retrospective analysis of consecutive patients aged 65 and above admitted with hip fracture to our hospital over a 5-week period. Patients without a PXR or experiencing severe complications were excluded. PXRs, medical records, drug charts and bowel charts were reviewed. Constipation was graded from 1+ to 3+ based on faeces in the sections of large bowel and rectum seen on PXR. A specific combination of oral and rectal laxatives was used based on such grading. The average time taken for the bowels to function was compared between patients with protocol-compliant management, minimally deviated management and non-compliant management.
RESULTS:
46 patients were included. Those with bowel management in line with our protocol (23) achieved bowel movement 1.7 days after surgery on average. By contrast, patients with minimal (9) and major deviations (14) from our protocol had a bowel movement respectively 3.6 and 4.2 days after surgery.
CONCLUSION:
These findings highlight the benefits of utilising admission PXRs in elderly patients with hip fracture to grade and manage constipation and, hence, reduce hospital stay and complications. Patients managed in line with our protocol experienced bowels functioning in less than 2 days, compared to over 4 days for patients with major deviations.