Abstract
Introduction:
Constipation affects up to one-third of adults over 65, with prevalence nearly doubling amongst hospitalised patients. Effective bowel management is crucial in older patients recovering from neck of femur (NOF) fractures, as postoperative constipation can delay mobilisation, increase complications, and prolong hospital stay. Despite debate on the reliability of pelvic X-rays (PXR) for assessing faecal loading, they offer an opportunity for early identification and proactive management.
Aim:
To evaluate and improve constipation management in patients admitted with NOF fractures by implementing a protocol guided by PXR findings.
Methods:
A retrospective review was conducted of patients aged ≥55 admitted with NOF fractures at Luton and Dunstable Hospital from September to October 2024. Exclusions included lack of admission PXR, no diagnosis of NOF, and postoperative complications. Constipation was graded (0 to 3+) based on faecal load on PXR. A bowel management guideline was then implemented, advocating early, targeted laxative use based on constipation grade. Post-implementation data from February to March 2025 was analysed using the same criteria.
Results:
Pre-implementation (n=47), mean time to bowel opening was 5 days (0–10). Patients with higher constipation scores (2–3+) had delayed bowel opening (5.7 vs 4.4 days). Only 8% received triple laxative therapy on day 0. Post-implementation (n=49), adherence to the protocol resulted in a reduced mean time to bowel opening of 3.8 days. Patients with significant faecal loading (2–3+) opened bowels on average 2 days earlier when the protocol was followed. Greater adherence correlated with shorter time to bowel opening.
Conclusion:
Introducing a standardised, proactive bowel management protocol based on PXR findings effectively reduced time to bowel opening in older patients with NOF fractures. Targeted laxative use from day 0, particularly in patients with significant faecal loading, may accelerate recovery and support earlier discharge. Continued education and adherence are key to sustaining improvement.
Comments
Good work !
Thank You for presenting your work. I have also done a similar patient population audit which focuses on improving surgical timings in NOF patients. Delirium is one of the factors which we are trying to manage as it leads to delayed surgical interventions and post operative complications. Perhaps I could implement similar strategy in my own audit.