P132 OUTCOMES AND REASONS FOR ADMISSION IN CROHN’S DISEASE. AN ANALYSIS OF NATIONWIDE INPATIENT SAMPLE 2016

Abstract

Abstract Objective Recent research suggests increasing nationwide admission for Crohn’s disease (CD), but the most common reasons for admission are not well known. We sought to enumerate the most common presentations of Crohn’s disease requiring admission in Nationwide Inpatient Sample (NIS) 2016 using ICD-10 codes. Methods We identified all adults aged greater than or equal to 18 years with a primary diagnosis of CD, using ICD 10 in Nationwide inpatient database. We analyzed inpatient demographics via chi-square. Inpatient mortality,Length of stay (LOS) and Total Charge (TOTCHG) was calculated using univariate and multivariable linear models. Results 60,244 patients with CD required inpatient admission. Majority of patients were females (53%), white (69%), with private insurance (46%) admitted to large bed sized (53.3%) teaching hospitals (68%). The common reasons for admission in CD patients included bowel obstruction at 24.6% (14,850) of which 57.8% (8,590) presented with small bowel obstruction (SBO). 42.1% (6260) were admitted with both SBO and LBO. Other reasons for admission were GI bleeding (6.5%) and fistulizing CD (2.4%). The inpatient mortality was 0.5%. Age was an independent predictor of mortality in these patients. (aOR 1.08, 95% CI 1.04–1.12; p=0.000). Protein energy malnutrition (PEM) (aOR 2.45, p=0.348), patients requiring pressor support (aOR 4.2, p=1.06) and those with bowel obstruction (aOR 1.1.9 p=0.84) had higher odds of mortality on multivariate analysis model, but couldn’t reach statistical significance. The mean LOS was 4.9 days and patients admitted over weekend had a longer LOS (coeff 0.22, 95% CI 0.08–0.37, p=0.002) as compared to weekdays on multivariate linear regression. The total cost attributable to Crohn’s disease was 706$ million. Independent predictors of increased total charge were Large bed sized hospitals, African-American, protein energy malnutrition, patients requiring pressor support and bowel obstruction in multivariate linear analysis. Conclusions The common reasons for inpatient admission in patients with CD include bowel obstruction, GI bleeding and fistulizing CD. Age was an independent predictor of mortality. The economic burden was highest amongst African-Americans, malnourished, patients requiring pressor support and those with bowel obstruction.