695 Time to Flexible Sigmoidoscopy or Colonoscopy in Patients Admitted With Ulcerative Colitis Has Decreased in the Past 5 Years

Abstract

INTRODUCTION: Early evaluation of patients with ulcerative colitis (UC) with flexible sigmoidoscopy (FS) or colonoscopy (C) enables assessment of disease activity, exclusion of infectious pathogens, or other conditions that may present similarly to UC. Early FS is also associated with improved outcomes of patients with active UC. The aim of this study was to determine the temporal trends in timing of FS/C in relation to day of admission in patients with UC in the past 5 years. METHODS: Retrospective cohort study using the NIS 2012-2016. Patients with an ICD9-10 principal diagnosis code for UC were included. Elective admissions were excluded. FS/C were identified using ICD9-10 procedural codes. Early FS/C was defined as performed within 48 hours of admission. Primary outcome was to determine the trends in timing of FS/C in patients admitted for UC. Secondary outcomes were determining the odds of early FS/C, inpatient mortality, morbidity, hospitalization length (LOS), total hospitalization charges and costs in patients undergoing early vs. non-early FS/C. Logistic regression was used to adjust for gender, age, Charlson Comorbidity Index, median zip code income, hospital region, location, size and teaching status. RESULTS: 156,720 patients with UC and were included. 3,845 (2.5%) underwent FS and 18,835 (12.0%) underwent C. The mean age was 45.4 years and 53.4% were female. The mean time to FS decreased from 3.2 to 3.0 days, while the mean time to C decreased from 2.8 to 2.5 days in the study period (P = 0.05). The total FS/C increased from 1,155 (3.9%) to 11,727 (35.5%) from 2012 to 2016. 13.3% of patients underwent C at teaching vs. 9.8% at non-teaching centers, while 2.6% underwent FS at teaching vs. 2.1% at non-teaching centers (P = 0.05). Early FS/C was associated with decreased odds of shock and multiorgan failure, as well as decreased resource utilization and LOS (Tables 1 and 2). CONCLUSION: For this dataset, FS/C rates were low in hospitalized patients with UC but are performed more frequently and earlier in the course of an admission. The total number and proportional use of inpatient FS/C increased from 2012-2016. This may reflect an increasing awareness of improved outcomes from earlier disease staging and/or earlier diagnosis of alternate disease processes that can be treated in a timely manner. Early FS/C was also associated with decreased costs, charges and length of hospitalization. These findings further highlight the importance of early endoscopic intervention in patients admitted with UC.