Abstract
Background and Objective:Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade.Methods:The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn’s disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time.Results:There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC.Conclusion and Global Health Implications:Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population.
Highlights
Inflammatory bowel diseases (IBD) are chronic, relapsing and remitting gastrointestinal diseases that require lifelong medical treatment, intermittent hospitalization, and need for surgical intervention in a proportion of patients.[1]
Another study found a nationwide increase in the annual incidence of hospitalization for pediatric Crohn’s disease (CD) and ulcerative colitis (UC) over a 12 year period, intestinal resection rates only increased in pediatric CD.[12]
As medical and surgical management continue to progress, the overall nationwide impact on hospitalization, surgical rates, and postoperative complications in pediatric inflammatory bowel disease (PIBD) remains unclear.We aimed to fill this gap in the literature by examining the change in these indices over the last decade
Summary
Inflammatory bowel diseases (IBD) are chronic, relapsing and remitting gastrointestinal diseases that require lifelong medical treatment, intermittent hospitalization, and need for surgical intervention in a proportion of patients.[1]. The ultimate impact of these advancing treatment options on outcomes in PIBD remains unclear. The impact of evolving treatment options on surgical complication rates in IBD is controversial. Studies comparing children with IBD treated with biologic versus nonbiologic therapy prior to bowel resection did not find an increased risk of postoperative complications in children receiving biologics.[13-15]. Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade
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