10 No Difference in Ulcerative Colitis Colectomy Rate in Pre and Post Biologic Era

Abstract

Background: Approximately 35% of patients with ulcerative colitis (UC) will require surgery some time during the course of their disease. However, this past decade has seen major changes in the medical management of UC with FDA-approval of anti tumor necrosis factor alpha (Anti-TNF), for moderate to severe UC. Anti-TNF has demonstrated beneficial impact on the short-term colectomy rates in patients with UC. However, limited data are available regarding the long-term efficacy. The aim of this study was to determine the trends in the rate of colectomy in pre and post biologics era in hospitalized patients with UC. Methods: Nationwide Inpatient Sample (NIS), maintained by the Healthcare Cost and Utilization Project of the Agency for Healthcare Quality and Research, is the largest all-payer inpatient hospitalization database in the US. Hospitalizations from prior to the approval of biologics for ulcerative colitis (the pre-biologic era (1998-2005) and for post-biologic period from 2006-2011 were used. Our study included all patients hospitalized for primary diagnosis of Ulcerative Colitis (ICD-9-CM 556.x) and secondary diagnosis of UC related comorbidities and procedures. Surgeries were classified as elective if the admission was coded as being elective, the source of admission was not the emergency room and surgery occurred on day 0 or 1 of hospitalization. It was defined as emergent if the patient was admitted from the emergency room, the admission was characterized as emergent, and the procedure was performed within 0, 1 day of admission. A previously published risk score was used to adjust for severity of ulcerative colitis hospitalization. Results: A total of 399,579 admissions with primary diagnosis of UC and 38,505 (10%) colectomies were recorded during this period. 212,951 (53%) were females and average age was 46 years. Descriptive data of the group are shown in table 1. There was no difference in colectomy rate in pre and post biologic periods (figures 1). Females, whites and teaching hospital had significantly high rates of colectomies (table 1). Rate of colectomy is significantly increased up to age 70 with lowest rate among the age-group 10-20 yrs (p <.0001). Conclusions: No difference in colectomy rate in UC was noted in post and pre biologic era. Females, whites and admission to teaching hospital are predictors of colectomy. Multivariate logistic regression on colectomy