P-210 YI Demographic and Clinical Differences Related to Pediatric IBD Care Among Hospitals Stratified by Annual Case Volume

Abstract

Prior research has demonstrated that adult patients admitted to hospitals with high inflammatory bowel disease (IBD) case volume demonstrate better clinical outcomes. The aim of this study was to analyze demographic and clinical differences related to pediatric IBD care among hospitals that were stratified based on annual case volume. This was a cross-sectional study using data from the Kids Inpatient Database (KID 2012). IBD-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification (ICD-9-CM) codes. Hospital volume was divided into low or high by assigning the threshold cutoff values of 1–20 and 21- or more annual IBD hospitalizations. Demographic and other variables of interest were extracted. Hospital costs were obtained using charge-to-cost ratios. Surgical and other procedures were identified using appropriate ICD-9-CM procedure codes. Comorbidity burden was calculated using the Elixhauser index. In 2012, there were a total of 8647 pediatric IBD discharges from 660 hospitals in the United States. Based on our stratification, 107 of these hospitals were classified as high-volume centers (HVCs) for pediatric IBD; the remaining 553 were deemed low-volume centers (LVCs). The greatest number of HVCs for pediatric IBD were in the Southern region of the United States (35.3%) while the least number were in the Western region (15.6%). HVCs were more likely to be associated with an academic teaching status compared to LVCs (97.1% versus 67.6%; P < 0.001). Pediatric IBD admissions at HVCs were also more likely to undergo surgical procedures related to the disease than LVCs (17% versus 10%; P < 0.001); however, the incidence of post-operative complications was not significantly different (P = 0.53). There were significantly greater hospital costs (median $11,000 versus $6000; P < 0.001) and lengths of stay (median 5 days versus 4 days; P < 0.001) associated with pediatric IBD care at HVCs compared to LVCs. Notably, we did not observe any significant differences in Crohn's disease phenotype, mode of presentation (elective versus emergent admit) or comorbid disease burden among children admitted to the 2 different types of centers. Pediatric IBD care at HVCs is associated with an increased frequency of surgical procedures related to the disease and greater hospital costs and lengths of stay. While this may reflect a referral bias for more severe disease, further research is indicated.