Changing Spectrum of IBD Admissions 1998-2008: Increasing Rates of Chronic Pain, Depression and Repeat Admissions

Abstract

Purpose: Despite treatment advances over the past decade, the number of inflammatory bowel disease (IBD; Crohn's disease (CD) and ulcerative colitis (UC)) patients requiring inpatient management has significantly risen. Clinical factors underlying these admissions have not been defined. We sought to characterize the factors contributing to IBD admissions in a referral population comparing hospitalizations in 1998 and 2008 respectively. Methods: Retrospective search of a comprehensive electronic medical record database was performed to identify IBD patients admitted to a tertiary referral hospital during 1998 and 2008. ICD9-CM diagnosis codes for CD or UC were used to identify admission records. Analysis was performed first with IBD as primary or secondary ICD9 diagnosis (Primary IBD) and then with IBD as any of 25 possible diagnostic codes (Total IBD). Statistical analysis was performed using SPSS software. Results: There were 262 Total IBD admissions in 1998 and 735 in 2008 (p<0.0001). Primary IBD admissions were 119 in 1998 and 447 in 2008 (p<0.0001). Overall hospital admissions increased from 1998 (28,926) to 2008 (35,505) and the rate of IBD admissions increased significantly during this time period (p<0.0001). The rate of Primary IBD admissions compared with Total IBD admissions increased between 1998 and 2008 (p<0.0001). CD admissions increased during the decade, which was opposite of UC, where admissions decreased (p=0.0001). The rate of CD surgical admissions remained unchanged, but decreased for UC (p=0.0001). C. difficile associated IBD admissions increased significantly from 1998 to 2008 (p=0.01). Overall IBD inpatient mortality decreased from 1998 to 2008 (p=0.03). IBD patients were significantly younger in 2008 compared with 1998, and had shorter lengths of stay (p=0.001). Repeat admissions for unique IBD patients increased from 18% in 1998 to 24% in 2008. Repeat admissions in 2008 were twice more common with CD patients than UC. Chronic pain admissions accounted for 5% of IBD admissions in 2008, which was not seen in 1998. IBD admissions with concomitant anxiety/depression increased significantly between 1998 (5%) and 2008 (15%). Conclusion: Despite advances in medical therapy, IBD patients are admitted at increasing rates between 1998 and 2008. Factors contributing to admission have changed, with chronic pain and depression rising significantly. CD patients are readmitted more frequently in 2008 compared with prior years. UC patients have fewer admissions and less surgery during this time period. Rising CD admissions and repeat admissions appear related to associated depression and chronic pain, which is an unrecognized unmet need in IBD patient care.