682 Postoperative Mortality and Complications Among the Elderly Following Surgery for Inflammatory Bowel Disease

Abstract

Background: Inflammatory bowel disease (IBD) is a chronic inflammatory condition associated with multiple disease-related and treatment-related complications. Population-based, longitudinal data regarding trends of IBD-related complications and rates of bowel resection are lacking in the United States. We aimed to study these temporal trends using a large nationally representative database. Methods: The National Inpatient Sample (NIS) databases (2002-2011), a subset of the Healthcare Cost and Utilization Project by Agency for Healthcare Research and Quality, were utilized for this study. The NIS is the largest all-payer inpatient care database, encompassing approximately 5-8 million hospitalizations from almost 1000 hospitals in the USA. Hospitalizations with diagnosis of IBD were captured by ICD-9 codes (Crohn's disease (CD): 555; Ulcerative colitis (UC): 556). IBD-related complications were identified using various ICD-9 diagnosis codes. Bowel resection was identified using the ICD-9 procedure codes 45.6-45.9. Analyses were performed separately for bowel resection rates for overall IBD, CD and UC. Linear regression was used to assess trends in various complications and resection rates. Analysis was performed using SAS 9.3. Results: Our study sample included 519,459 hospitalizations-related to IBD. The mean age of hospitalizations was 50 years, and the majority of patients were Caucasian (80%) and female (58%). The rate of Clostridium difficile infection increased significantly from 2002 (2.0%) to 2011 (4.04%) (slope 0.222, p<.001). Similarly, rates of sepsis and venous thromboembolism (VTE) substantially increased over the same time period (sepsis: 5.5 to 10.6%, slope 0.623, p<.001; VTE: 2.1 to 3.4%, slope 0.154, p<.001). The increased rate of sepsis was mainly driven by patients over age 60 (9.2 to 16.7%, p<.001). No significant increase in the rates of fistula, abscess, perforation or toxic megacolon was seen. For overall IBD, rates of bowel resection decreased significantly over the years from 10.4% to 6.9% (slope -0.376, p<.001). Resection rates decreased significantly for both UC (9.9 to 7.4%, slope -0.256, p=0.022) and CD (10.6 to 6.7%, slope -0.455, p <.001). Among CD hospitalizations, the majority of the decrease in resection rates was seen in the patients younger than age 60. Conclusion: Our study, using a large inpatient hospitalization database, demonstrated a significant increase in rates of clostridium difficile infection, sepsis, and VTE among IBD-related hospitalizations. A substantial decrease in rates of bowel resection was seen in IBD patients, especially amongst young patients.