Mo1692 Short-Term Outcomes of Percutaneous Versus Surgical Treatment of Abdominal Abscesses in Crohn's Disease - a Nationwide Study

Abstract

Introduction: Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses. Methods: We identified all adult CD related hospitalizations from the Nationwide Inpatient Sample 2007, the largest allpayer hospitalization database in the United States comprising over 1000 hospitals from 40 states. Intra-abdominal abscesses were identified from all non-elective admissions. Using administrative codes, treatment modality was categorized into 3 strata medical treatment alone, percutaneous drainage (perc), and surgical treatment (surg). We examined the impact of treatment modality on length of stay, hospitalization charges, and need for total parenteral nutrition (TPN) and stoma creation. Results: There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD (mean age 41 years, 44%women). Approximately 39% were treated by medical treatment alone, 29% with percutaneous drainage, and 32% with surgery (Figure 1). The factors predictive of interventional treatment (perc or surg) were malnutrition (OR 2.4, 95%CI 1.3-4.5), and admission to a teaching hospital (OR 2.1, 95%CI 1.4-3.0). Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days respectively. Early percutaneous drainage (< 2 days) was associated with shorter hospitalizations (-8 days, 95%CI -11 to -5 days) and lower need for TPN (OR 0.45, 95%CI 0.20 1.04) (Figure 2). 27% of patients treated with surgery required creation of a temporary or permanent stoma. Compared to percutaneous drainage, surgical treatment was associated with longer hospitalizations (3.3 days, 95%CI 1.1-5.4 days), and greater hospitalizations costs ($34,314) Conclusion: We describe, for the first time, a nationwide pattern in the treatment of abdominal abscesses. Percutaneous drainage is associated with shorter length of hospital stay and lower hospitalization costs than surgical treatment. Early treatment (either percutaneous or surgical) is predictive of shorter hospitalization.