640 Outcomes in Geriatric Patients Admitted for IBD Management: A National Study

Abstract

INTRODUCTION: The proportion of the population considered geriatric continues to rise in the United States, as well as in most of the developed world. Based on this trend, combined with increased prevalence of inflammatory bowel disease (IBD), the burden of caring for elderly patients with IBD will likely rise. Given the complications of hospitalization in this cohort, we set to examine if elderly patients age >75 were at higher risk of poor outcomes when admitted for their IBD. METHODS: This national inpatient sample (NIS) from 2016 (most recent available) was queried for all cases of Crohn's or ulcerative colitis (UC) where this was the principle cause for admission (first diagnosis code) based on ICD-10. Outcomes for patients age >75 were compared to those <75 using survey-adjusted logistic/linear regression to examine mortality, length of stay, and hospitalization costs. Adjustment was made for the Elixahauser mortality score (a validated measure of comorbidities), undergoing surgery during the admission, and the presence of C diff infection. Crohn's and UC were analyzed separately. RESULTS: In 2016, admissions for UC were 35,950 and for Crohn's were 71,040. In UC, 1.4% of geriatric vs 0.2% of non-geriatric patients died in the hospital (P < 0.001). Similar results were found in Crohn's at 1.0% versus 0.1% (P < 0.001). Average Elixhauser mortality index (a validated measure of comorbidities) was higher for geriatric patients for UC (8.4 vs 4.8, P < 0.001) and Crohn's (7.3 vs 3.3, P < 0.001). In the regression analysis for Crohn's, non-geriatric patients had a OR = 0.25 of death (P = 0.001) but no significant difference in length of stay (P = 0.119) or costs (P = 0.446). For the UC regression, similar findings of an OR = 0.19 of death (P < 0.001) but no change in LOS (P = 0.529) or costs (P = 0.927) were seen. For all admissions in NIS, an OR = 0.50 was seen for the same controlling variables. CONCLUSION: In this U.S. national cohort from 2016, age >75 was associated with a notably higher odds of death in both UC and Crohn's patients, with nearly four times the odds of inpatient mortality even after adjustment for comorbidities. This is more than double the mortality difference compared to non-IBD admissions. Further research is needed to customize care for this growing group of individuals to improve outcomes.