Colectomy for Ulcerative Colitis in a Large Private Insurance Claims Database

Abstract

Purpose: To describe the types of colectomy and follow-up surgical procedures in a population of privately insured individuals with ulcerative colitis (UC). Methods: This was a retrospective analysis of claims data of employees and dependents from several large corporations in the US (MarketScan). The database includes 357.5 million outpatient claims and 1.4 million inpatient admissions. We identified a cohort of patients (pts) with a diagnosis of UC who underwent a colectomy between 2001 and 2004 inclusive. ICD-9 and CPT4 codes were used to identify UC pts, types of colectomy and subsequent related surgeries within the first 180 days after initial colectomy. Types of colectomy were classified into five categories: (1) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), (2) subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileorectal anastomosis, (3) TPC with ileostomy, (4) segmental colectomy with ileal or colonic anastomosis, or (5) other partial colectomy (OPC). Follow-up surgeries were compared across colectomy types. Results: A total of 25586 cases of UC were identified. The study sample includes 215 UC pts who had a CPT4 procedure code for colectomy and 180-days of pre- and post-colectomy follow-up. The pt group was 52% male (mean age 42.6 years) and most often insured by a PPO (39%). Common co-morbidities included diabetes (8%) and chronic pulmonary disease (8%). The colectomy distribution was: (1) TPC with IPAA (n = 108, 50%); (2) SC with ileostomy (n = 48, 22%); (3) TPC with ileostomy (n = 28, 13%); (4) segmental colectomy with ileal or colonic anastomosis (n = 10, 5%); and (5) OPC (n = 21, 10%). Many patients had a second colectomy-related surgery: ostomy (n = 5, 2%), ostomy closure (n = 91, 42%), and proctectomy (n = 15, 7%). Within the 180 days post-colectomy, 71% of pts with TPC-IPAA had an ostomy closure, and 29% of pts with SC-ileostomy and Hartmann pouch or ileorectal anastomosis had a proctectomy. Conclusions: In this retrospective study of privately insured UC pts, the most common types of colectomy were TPC-IPAA and SC-ileostomy, both leading to multi-staged surgeries. Among 215 pts with a colectomy, we observed at least 111 additional colectomy-related surgeries. These results highlight the burden of follow-up surgeries in many UC pts undergoing colectomy. Supported by Schering-Plough.