Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis

Flávia Gonçalves Musauer Palacio,Jéssica Pronestino De Lima Moreira,Heitor Siffert Pereira De Souza,Ronir Raggio Luiz,Lucila Marieta Perrotta De Souza,Cyrla Zaltman

doi:10.1186/s12876-021-01781-x

Flávia Gonçalves Musauer Palacio, Jéssica Pronestino De Lima Moreira + Show 4 more

Open Access

https://doi.org/10.1186/s12876-021-01781-x

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Abstract

BackgroundThe prevalence of inflammatory bowel disease (IBD) is increasing globally, and the disease is frequently managed surgically. The aim of this study was to investigate the time trends and geographic distribution of IBD hospitalizations, surgeries and surgical-associated lethality.MethodsData from the Brazilian Health Public System were retrospectively collected regarding hospitalizations, in-hospital deaths, IBD-related surgical procedures and lethality from 2005 to 2015.ResultsThis eleven-year period revealed decreases in the rates of hospitalization (24%), IBD-related surgeries (35%), and IBD-related surgical lethality (46%). Most surgeries were performed in Crohn’s disease patients, and the predominant procedure was small bowel resection, mostly in young adults. A higher prevalence of ulcerative was observed throughout the country. The highest hospitalization and surgical rates were observed in the more industrialized regions of the South and the Southeast and in the municipalities integrated with metropolitan regions (MRs). The highest surgical-related lethality rates were seen in the less-developed regions and in municipalities not integrated with MRs. The length of hospital stay showed a slight increase throughout the period.ConclusionsBrazil follows the global trend of decreases in hospitalizations, lethality, surgeries, and surgical lethality associated with IBD. The unequal distribution of hospitalizations and surgeries, concentrated in the industrialized areas, but with a shift towards the Northeast and from urbanized to rural areas, indicates ongoing changes within the country. Reductions in the rates of IBD-related hospitalizations, surgeries and lethality suggest the effectiveness of decentralization and improvements in the quality of public health services and the advances in medical therapy during the study period.

Highlights

The prevalence of inflammatory bowel disease (IBD) is increasing globally, and the disease is frequently managed surgically
Further analysis revealed that hospitalizations for Crohn’s disease (CD) were proportionally higher among patients aged 20–39 years, whereas in patients with ulcerative colitis (UC), the highest proportion of hospitalizations was among patients aged 40 years or older
The geographic distribution of IBD hospitalizations showed an overall higher prevalence of UC, with greater concentrations of hospitalizations in the South and the Southeast, where surgery rates decreased more, in municipalities not integrated with Metropolitan region (MR)

Summary

Introduction

The prevalence of inflammatory bowel disease (IBD) is increasing globally, and the disease is frequently managed surgically. For CD, the estimated chance of surgery throughout the patient’s lifetime has been reported to be 70–80% [13, 18, 19]. This might considerably affect the patient’s quality of life and might impose a relevant socioeconomic impact on patients and a burden to healthcare systems [20, 21], especially considering that IBD frequently originates in young adults [22]

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