{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:01:38Z","timestamp":1763643698274,"version":"3.41.2"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T00:00:00Z","timestamp":1668470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000149","name":"Canadian Association of Gastroenterology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000149","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>When constipation is refractory to first\u2010line interventions, antegrade enema use may be considered. We aimed to assess the impact of this intervention on healthcare utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a population\u2010based, quasi\u2010experimental study with pre\u2013post comparison of the intervention group and a non\u2010equivalent control group using linked clinical and health administrative data from Ontario, Canada. Subjects included children (0\u201318\u2009years) who underwent antegrade enema initiation from 2007 to 2020 and matched controls (4:1) from the general population. To assess the change in healthcare utilization following antegrade enema initiation, we used negative binomial generalized estimating equations with covariates selected a priori.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>One hundred thirty\u2010eight subjects met eligibility criteria (appendicostomy\u00a0=\u00a055 (39.9%); cecostomy tube\u00a0=\u00a083 (60.1%)) and were matched to 550 controls. There was no significant difference in the change in the rate of hospitalizations (rate ratio (RR) 1.05, 95% confidence interval (CI) 0.35\u20131.75), outpatient visits (RR 1.05, 95% CI 0.91\u20131.18), or same\u2010day surgical procedures (RR 1.51, 95% CI 0.60\u20132.43) across cases in 2\u2009years following antegrade enema initiation compared with controls. Cases had an increased rate of emergency department (ED) visits, which was not observed in controls (RR 1.52, 95% CI 1.11\u20131.79), driven in part by device\u2010related complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Inferences<\/jats:title><jats:p>Understanding healthcare utilization patterns following antegrade enema initiation allows for effective health system planning and aids medical decision\u2010making. The observed increase in ED visits for device\u2010related complications speaks to the need to improve preventive management to help mitigate emergency care after initiation of antegrade enemas.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14495","type":"journal-article","created":{"date-parts":[[2022,11,15]],"date-time":"2022-11-15T13:14:53Z","timestamp":1668518093000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of antegrade enema initiation on healthcare utilization in pediatric patients: A population\u2010based cohort study"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4204-922X","authenticated-orcid":false,"given":"Michelle J.","family":"Gould","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology, and Nutrition Hospital for Sick Children  Toronto Canada"},{"name":"Department of Paediatrics University of Toronto  Toronto 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