723 Evolution in Hospitalization and Outcomes of Patients With Inflammatory Bowel Disease: Nationwide Study From 1998-2014

Abstract

INTRODUCTION: Approval of the first biologic agent by the FDA in 1998, revolutionized the management of inflammatory bowel disease (IBD). We hypothesized that this paradigm shift would improve outcomes amongst the hospitalized IBD patients. Hence we investigated the trends in the hospitalization of IBD patients and related outcomes using National database. METHODS: We queried the Nationwide inpatient sample (NIS) database from the year 1998 to 2014. Hospitalized adult patient with IBD, i.e., Crohn's disease (CD) or ulcerative colitis (UC), their outcomes and procedures (including surgeries), were identified using ICD-9-CM diagnosis and procedure codes. Trends were analyzed using Cochrane Armitage test for categorical variables and the nonparametric test for continuous variables. We calculated the national estimates using the discharge weights. RESULTS: Total of 3,876,583 patient with IBD were included in the study. The mean age of the study population was 57.8 years; females were 57.6% and 67.2% White. Baseline characteristics of the patients, hospital characteristics and insurance types are shown in Table 1. Hospitalization of the patient with IBD nearly doubled from 70/100,000 US adult population to 125/100,000 (Figure 1). Since 1998, inpatient mortality remained stable, with an overall mortality rate of 1.5%. Length of stay (LOS) decreased, a numerically small decrease from 6.2 to 5.5 days, while hospital charges increased from $14,771 to $47,548 (Figures 3 and 4). Prevalence of anemia and transfusion utilization increased to 28.6% and 9.2% respectively in 2014. Co-morbidities such as acute kidney injury (1.4% to 13.2%), venous thromboembolism (1.9% to 3.5%) and Clostridium difficile infection (1.4% to 5.2%) also increased along with hospitalization requiring ICU (1.6% to 3%). However, CD and UC related surgery decreased from 15.9% to 10.7% and 5.7% to 3.5% respectively. Utilization of inpatient lower endoscopy also declined from 23% to 13.1%. Table 2 shows trends in complication, outcomes, and resource utilization over the study period. CONCLUSION: Over 17 years, hospitalization of patients with IBD has increased. Mortality, perforation rate, colon cancer prevalence, and LOS remained steady with marginal changes numerically. However, hospitalization charges, along with other co-morbidities/complications related to IBD increased significantly even though utilization of endoscopy and surgery has declined.