Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease (IBD): 2016 ACG Presidential Poster Award

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Introduction: Appendectomy for acute appendicitis is the most common emergent abdominal surgery but less is known about hospital outcomes within the IBD population. Our study compared hospital outcomes of appendectomy between those with Crohn's disease (CD) and ulcerative colitis (UC) and those without IBD. Methods: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2009-2013). Patients with either UC or CD undergoing an appendectomy for appendicitis were identified using ICD-9-CM codes. The following patients were excluded: (a) Age < 18 years; (b) Patients listed with both diagnoses of UC and CD; (c) Surgery performed electively. Patients with CD and UC were compared to patients without IBD through multivariate analyses in terms of Patient Safety Indicators (PSI), postsurgical complications, length of stay (LOS) and cost. Results: Among the total of 849,312 patients, there were 2416 CD patients (0.003%) and 1845 UC patients (0.2%). Compared to non-IBD patients, CD patients were more likely to develop post-surgical complications, have prolonged LOS, and increased hospital costs (Table 1). Significant post-surgical complications included pulmonary embolism (PE) and post-operative anemia. UC patients were more likely to have prolonged LOS, incur higher hospital costs and more PSI's (Table 1). Although post-surgical complications overall were not statistically significantly different between the UC patients and non-IBD patients, individual analysis of post-surgical complications demonstrated that UC patients were more likely to develop deep venous thromboses (DVT). Finally, analysis of appendicitis type showed that CD patients were more likely to have perforated appendices and undergo open appendectomy, while UC were more likely to have non-perforated appendices (Table 2).Table 1: Patient with CD undergoing appendectomy for appendicitis were more likely to have post-surgical complications, increased legnths of stay and incur higher hospital costs compared to those without IBD. Patients with UC were more likely to have increased lengths of stay, increased hospital costs and more PSI's compared to patients without IBD.Table 2: Patients with CD were more likely to have perforated appendices and required open appendectomy. Patients with UC were more likely to have non-perforated appendices and laparoscopic appendix removal.Conclusion: Our study is the first to show that patients that with IBD undergoing appendectomy for appendicitis had prolonged LOS and incurred higher hospital costs. CD patients undergoing appendectomy are likely to have PE and post-operative anemia, while UC patients are more prone to PSI and DVT. CD patients are most likely to undergo an open appendectomy and have a perforated appendix. This can likely be attributed to the transmural disease process of CD. This study can help guide surgical risk discussions with the IBD patients, particularly PE and DVT. Therefore, DVT prophylaxis is more important in IBD patients undergoing appendectomy for appendicitis.