Background: Constipation can be a significant clinical challenge, impacting patient care and extending hospital stays. We examined the effects of constipation on Hepatocellular carcinoma patients, especially due to increased risk from opioid use in cancer patients, which may affect overall hospital outcomes.

Methods: We retrospectively analyzed critically ill patients with hepatocellular carcinoma in the 2019 and 2020 National Inpatient Sample databases. Multivariate regression analysis was applied to adjust for confounding variables and study important outcomes: mortality, length of stay, the total cost of hospitalization, sepsis, acute kidney injury, acute respiratory failure, malnutrition, obesity, weight loss, diarrhea, nausea and vomiting, fatigue, and involvement of palliative care.

Results: Of the 38365 patients admitted with Hepatocellular carcinoma, 4685 (12.2%) had a secondary diagnosis of constipation, and 33680 had no constipation. After adjusting for confounding variables, mortality (OR 0.69 95% CI 0.49-0.96, P=0.028) and total hospitalization charges [-13906 USD, 95% CI -22750- (-5063), p = 0.002] were significantly reduced in HCC patients with concurrent constipation, while there was no difference in the length of stay between the two cohorts (0.93, 95% CI 0.37-1.48, p = 0.001. Constipation was associated with decreased odds of obesity (OR 0.78, 95% CI 0.61-0.99, P=0.042) and acute respiratory failure (OR 0.65 95% CI 0.44-0.95, p = 0.029); however, it was coupled with an increased risk of weight loss (OR 1.60 95% CI 1.07-2.40, p= 0.021), nausea/vomiting (OR 2.24 95% CI 1.55-3.24, p < 0.001), fatigue (OR 4.32 95% CI 2.25-8.31, p < 0.001), palliative care involvement (OR 1.88 95% CI 1.55-2.29, p < 0.001), malnutrition (OR 1.72 95% CI 1.46-2.04, p < 0.001) and opioid use disorder (OR 2.50 95% CI 1.62-3.84, p < 0.001).

Conclusion: Constipation has been associated with reduced mortality and overall hospitalization costs; however, it is also associated with multiple adverse health events that can contribute to increased morbidity. Additional prospective studies are required to confirm the results of our analysis. Early identification of constipation in high-risk cancer patients could be crucial for predicting morbidity and mortality, as well as aiding in risk stratification to improve outcomes.