INTESTINAL PERFORATIONS IN PATIENTS WITH IBD: AN ANALYSIS OF THE NATIONAL INPATIENT SAMPLE 2015-2019

Abstract

Abstract BACKGROUND Inflammatory Bowel Disease results in numerous complications due to inflammatory damage to the intestinal mucosa. One complication of IBD is perforation of the intestines. The aim of our study was to study the impact of IBD on clinical outcomes in patients with intestinal perforation. METHODS The Nationwide Inpatient Sample (NIS) database encompasses approximately 7 million inpatient hospitalizations annually in the United States. Data were extracted from the National Inpatient Sample (NIS) Database for the years 2015-2019. Patients aged 18 years and above with diagnoses of IBD and intestinal perforation were identified using ICD codes. Multivariate regression analysis was used to estimate the odds ratios of in-hospital mortality, the average length of hospital stay (LOS), and hospital charges using STATA 17. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. RESULTS We identified 221,820 patients with IBD of which 43,509 patients were matched to those with intestinal perforations. Average age was 56.61 years. There was a significant increase in inpatient mortality (OR 3.10, CI 2.06-4.67, p<0.0001), total cost of hospitalization ($140,391, CI 108,576.3 - 172,205.9, p<0.0001), and hospital length of stay (9.42 days, CI 7.67 - 11.2, p<0.0001) in patients with IBD with a concurrent diagnosis of intestinal perforation when compared to IBD patients without intestinal perforations. On multivariate analysis, positive predictors of mortality were Acute Kidney Injury (AKI) (OR: 3.734811 p-value: <0.001; 95% CI: 3.159078 - 4.41547) and sepsis (OR: 5.616263 p-value: <0.001; 95% CI: 4.777288- 6.602577). LOS was increased in patients with hospitalizations complicated by AKI (OR 2.577361; p-value: <0.001; 95% CI: 2.327294-2.827427) and sepsis (OR 3.096738; p-value: <0.001; CI: 2.754462- 3.439013). Total hospital charges were increased in patients with hospitalizations complicated by sepsis ($41,685.55; p-value: <0.001; 95% CI: 35,262.58-48,108.52) and AKI ($34,990.15; p-value: <0.001; CI: $30,215.96-39,764.34). CONCLUSIONS Our study demonstrates the presence of intestinal perforations in hospitalized patients with IBD is associated with poor outcomes in terms of mortality, length of stay, and total hospital charges. Furthermore it was found that the presence of both sepsis and AKI are also associated with worsened outcomes. Our study is novel because there are minimal data that investigate the clinical outcomes associated with IBD patients with intestinal perforations. Our study demonstrates that the presence of intestinal perforations poses a significant mortality risk in these patients, along with concurrent sepsis and AKI.Further studies would be beneficial to identify further risk factors contributing to worsening outcomes.