S967 Inflammatory Bowel Diseases Results in Worse Hospital Outcomes in Patients Admitted for Acute Diverticulitis: A Study of the National Inpatient Sample

Abstract

Introduction: The association between Acute Diverticulitis (AD) and Inflammatory Bowel Diseases (IBD) is extremely rare in literature and not well studied as a result of the scarcity of reports and overlapping clinical and radiological features. In this study, we aim to investigate the clinical impact of IBD on the outcomes of patients admitted for AD. Methods: The National Inpatient Sample Database of the years 2016 to 2019 was analyzed, and patients who were hospitalized for AD, with or without a secondary diagnosis of IBD (Crohn’s Disease and ulcerative colitis) were identified using the 10th Revision of International Classification of Diseases codes. Univariates and Multivariate logistic regression analysis was performed to determine risk difference in mortality and AD-related complications. Data was considered statistically significant with p-value < 0.05. Results: A total of 313,054 adults AD hospitalizations were identified, among which 3090 (1%) had a history of IBD. AD patients baseline characteristics and comorbidities are listed in Table stratified by IBD diagnosis. IBD patients found to have 27% increase in risk of AD than IBD-free patients (adjusted odds ratio (aOR) 1.27, p< 0.001) with no difference in risk of mortality between the two groups (aOR 1.37, p=0.437). AD/IBD patients had significant increased risk of bowel perforation (aOR 3.41, p=0.04), sepsis (aOR 1.69, p=0.002), septic shock (aOR 3.16, p< 0.001), acute kidney injury (aOR 1.35, p=0.036) and undergoing colonic resection (aOR 1.28, p=0.018) than AD/non-IBD group. In term of healthcare resources utilization, IBD patients had a prolonged length of stay (adjusted mean difference (aMD) 1.39 days, p< 0.001) and increased cost of care (aMD 16993$, p< 0.001) when hospitalized for AD when compared to non-IBD patients. (Figure) Conclusion: This is the first descriptive analysis to demonstrate the effect of IBD on outcomes of patients with AD. IBD patients are at higher risk of developing AD, and IBD patients admitted for AD were found to have had higher risk of bowel perforation, sepsis, septic shock, acute kidney injury and undergoing colonic resection with significant increase in healthcare resources utilization. As such association is unique in clinical practice, misdiagnosis can occur and therefore physicians should keep high index of suspicion in this challenging scenario to primarily avoid catastrophic outcomes and decrease resources utilization.Figure 1.: Forest plot of outcomes in patient hospitalized for AD with history of IBD, compared to non-IBD patients. (AD=Acute Diverticulitis, IBD=Inflammatory Bowel Diseases) Table 1. - Baseline characteristics of AD patients stratified based on diagnosis status of IBD VARIABLE ALL AD %, NO. WITHOUT IBD %, NO. WITH IBD %, NO. P value (100.0) 313054 99.0 (309964) 1.00 (3090) Patient’s characteristics Age, mean years 58.4 58.4 60.3 0.001 Female 49.8 (155901) 49.8 (154362) 54.3 (1678) 0.028 Racial distribution < 0.001 White 76.3 (238860) 76.3 (236503) 83.4 (2577) Black 8.62 (26985) 8.65 (26812) 6.46 (200) Hispanic 11.0 (34436) 11.1 (34406) 6.29 (194) Others 2.29 (7169) 2.29 (7098) 2.65 (82) Insurance type 0.002 Medicaid 36.5 (114265) 36.5 (113137) 43.4 (1341) Medicare 11.2 (35062) 11.2 (34716) 9.43 (291) Private 45.7 (143066) 45.7 (141654) 42.7 (1319) Uninsured 6.49 (20317) 6.52 (20210) 4.38 (135) Charlson comorbidity index score 0.082 1 22.1 (69185) 22.1 (68502) 21.5 (664) 2 9.20 (28801) 9.18 (28455) 11.6 (358) ≥3 9.86 (30867) 9.85 (30531) 11.3 (349) Median annual income, us$ 0.281 1–43,999 23.9 (74820) 23.9 (74081) 23.1 (714) 44,000–55,999 26.1(81707) 26.2 (81211) 23.4 (723) 56,000–73,999 26.3 (82333) 26.3 (81521) 27.0 (834) ≥74,000 23.5 (73568) 23.4 (72532) 26.2 (810) Hospital characteristics Hospital region 0.079 Northeast 20.8 (65115) 20.8 (64473) 24.7 (763) Midwest 22.6 (70750) 22.6 (70052) 23.4 (723) South 38.0 (118961) 38.0 (117786) 35.2 (1088) West 18.4 (57602) 18.4 (57033) 16.5 (510) Hospital bed size 0.338 Small 23.3 (72942) 23.3 (72222) 22.6 (698) Medium 31.0 (97047) 31.0 (96089) 28.8 (890) Large 45.6 (142753) 45.6 (141344) 48.5 (1499) Hospital location Rural location 9.76 (30554) 9.78 (30314) 8.09 (250) 0.023 Urban location 25.0 (78264) 25.0 (77491) 21.3 (658) Teaching hospital 65.2 (204111) 65.1 (201787) 70.5 (2178) Comorbidities Hypertension 41.8 (130857) 41.8 (129565) 40.6 (1255) 0.534 Diabetes mellitus 13.9 (43515) 14.0 (43395) 11.3 (349) 0.055 Smoking history 40.0 (125222) 39.9 (123676) 42.7 (1319) 0.171 Hyperlipidemia 29.5 (92351) 29.5 (91439) 30.4 (939) 0.617 Obesity 19.5 (61046) 19.5 (60443) 16.0 (494) 0.030 Chronic kidney disease 6.45 (20192) 6.44 (19962) 8.41 (260) 0.045 Coronary artery disease 10.2 (31932) 10.2 (31616) 11.4 (352) 0.284 Peripheral vascular disease 1.07 (3350) 1.06 (3286) 2.27 (70) 0.003 Congestive heart failure 5.01 (15684) 4.99 (15467) 7.44 (230) 0.005 Chronic obstructive lung disease 8.68 (27173) 8.66 (26843) 11.0 (340) 0.039 Chronic liver disease 4.97 (15559) 4.97 (15405) 5.02 (155) 0.961 Constipation 8.46 (26484) 8.46 (26223) 8.74 (270) 0.800 AD=Acute Diverticulitis, IBD=Inflammatory Bowel Disease.