Inflammatory Bowel Disease Admissions Research Articles

Hospital admissions for pyoderma gangrenosum in Spain (1999-2021): Epidemiological and clinical characteristics, temporal trends, and factors associated with poor prognosis and higher cost.

Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis that can be idiopathic or associated with other diseases. The aim was to analyze the epidemiological and clinical characteristics, temporal trends, risk factors for poor prognosis, and admission costs associated with PG in Spain. We conducted a retrospective study, based on the Hospital Discharge Registry of the Spanish National Health System in Spain from 1999 to 2021. Of 82,161,670 admissions during the study period, 4901 were for PG (hospitalization rate of 59.7/1,000,000 admissions). PG hospitalizations increased from 28.8/1,00,000 in 1999 to 91.9/1,000,000 in 2021. PG was a primary cause of admission in 60.5% of cases, and 58.4% of patients were women. The main PG-related comorbidities were inflammatory bowel disease (15.7%) and neoplasms (10%). There was a significant increase over the years in admissions for inflammatory bowel disease, monoclonal gammopathy of undetermined significance, and lymphoma, as well as an increase in diseases unrelated to PG, such as hypertension, diabetes, and chronic kidney disease. The hospital mortality rate was 5.6%. Death was associated with PG being a primary diagnosis, older age, leukemia, neoplasms, diabetes, and chronic kidney disease. The cost of treatment increased over the years and was higher in older people. PG cases in the inpatient setting in Spain over the past 23 years make up a tiny proportion of all hospital admissions, although the rate of hospitalization for PG has increased in the last two decades.

S1249 Quality Improvement: VTE Prophylaxis for Inflammatory Bowel Disease Admissions - Room for Improvement

S1249 Quality Improvement: VTE Prophylaxis for Inflammatory Bowel Disease Admissions - Room for Improvement

Burden of delirium on mortality and healthcare resource utilization in geriatric patients hospitalized for inflammatory bowel disease

Background Delirium is prevalent in elderly patients, linked to elevated mortality rates, heightened healthcare resource use, and caregiver burden. Inflammatory bowel disease (IBD) poses various delirium risk factors, yet the impact on geriatric IBD patient outcomes remains unexplored. Methods Using 2016–2019 National Inpatient Sample data, we identified ≥65-year-old patients admitted for IBD (Crohn’s, ulcerative colitis) management stratified by delirium presence as a secondary diagnosis. The study aimed to assess delirium’s impact on geriatric IBD patient outcomes. Results Among 67,534 elderly IBD admissions, 0.7% (470) developed delirium. The delirium group had a 4.8-fold increase in in-hospital mortality risk (odds ratio 4.80, P < 0.001, 95% confidence interval [CI] 1.94–11.8). IBD patients with delirium experienced prolonged length of stay (adjusted mean difference 5.15 days, 95% CI 3.24–7.06, P < 0.001) and increased care costs (adjusted mean difference $48,328, 95% CI $26,485–$70,171, P < 0.001) compared to those without delirium. Conclusion Elderly IBD patients with delirium face higher mortality risk, prolonged hospitalization, and increased healthcare costs. Clinicians should recognize delirium’s detrimental effects in this vulnerable group and adhere to preventive protocols for improved care.

Evaluation of emergency hospital admissions for inflammatory bowel disease as a possible marker of quality of care of British IBD inflammatory bowel disease units

BackgroundKey performance indicators (KPIs) are required to facilitate quality improvement for inflammatory bowel disease (IBD). Emergency admissions for IBD may represent a possible KPI.MethodsIBD emergency admissions for 2018–2019 from Hospital...

The prevalence and impact of psychiatric comorbidities on hospitalized inflammatory bowel disease patients in the United States: insights from the National Inpatient Sample from 2009-2018.

Patients with inflammatory bowel disease (IBD) are at increased risk of anxiety and mood disorders. This study examines the temporal trends and clinical impact of anxiety and mood disorder diagnoses in hospitalized IBD patients in the United States during a 10-year period. Using the National Inpatient Sample from 2009-2018, all IBD-related discharges in adults were analyzed. Primary outcomes were the prevalence and temporal trends of mood disorder and anxiety diagnoses for IBD-related admissions. The impact of the psychiatric comorbidities on clinical outcomes was also evaluated. A total of 1,718,736 IBD-related discharged were identified. A diagnosis of anxiety or a mood disorder was found to have a prevalence of 16.44% and 18.97%, respectively, amongst IBD-related admissions. The prevalence of anxiety disorders amongst hospitalized IBD patients increased significantly (from 12.13% to 20.26%), whereas the prevalence of mood disorders did not (17.46% and 18.9%). IBD admissions with psychiatric comorbidities had lower rates of IBD-related complications or mortality during hospitalization compared to IBD admissions without comorbid psychiatric diagnoses. This population, however, was more likely to experience certain comorbidities such as Clostridioides difficile, pneumonia, and venous thromboembolism, as well as a longer hospitalization. The prevalence of comorbid anxiety among hospitalized IBD patients in the United States matches or exceeds the prevalence of anxiety in the general hospitalized population. Given its association with more in-hospital complications and a longer hospital stay, it is important to further understand how psychological screening and mental health services can improve the management of hospitalized IBD patients.

Assessing the Impact of the COVID-19 Pandemic on the Severity of Pediatric Inflammatory Bowel Disease Admissions and New Diagnoses.

The COVID-19 pandemic has introduced new challenges to the diagnosis and management of pediatric inflammatory bowel disease (IBD). Many patients have had only limited access to their providers through telemedicine, and many chose to delay nonemergent treatment. A retrospective chart review of patients with IBD seen by the Pediatric Gastroenterology Division at Doernbecher Children's Hospital from January 2018 to August 2021 was conducted. The study cohort was divided into 2 groups: those presenting before the onset of the COVID-19 pandemic (January 1, 2018 to February 28, 2020) and those presenting during the pandemic (March 1, 2020 to August 1, 2021). Variables collected included: age, sex, race, ethnicity, IBD type, insurance type, location of residence. Primary outcome measures selected focused on disease severity, initial type of treatment, or surgical intervention offered. A subgroup analysis of the new diagnosis patients was performed. Data were analyzed using independent t-tests, chi-squared analysis, and Wilcoxon rank sum tests. Two hundred and eleven patients met inclusion criteria, 107 (72 new diagnoses, 35 admissions) within the pre-COVID epoch and 104 (67 new diagnoses, 37 admissions) within the during-COVID epoch. Patients in the during-COVID epoch had higher fecal calprotectin level and were more likely to be started on a biologic as initial treatment. Patients admitted during COVID for IBD flare were more likely to require surgical intervention. Subgroup analysis of newly diagnosed patients revealed higher incidence of comorbid depression and anxiety. Our review identified increased disease severity in newly diagnosed pediatric patients with IBD as well as pediatric patients admitted for flare during COVID. Increases in anxiety and depression rates during COVID may have contributed to worsened disease severity.

Predicting inpatient mortality in patients with inflammatory bowel disease: A machine learning approach.

Data are lacking on predicting inpatient mortality (IM) in patients admitted for inflammatory bowel disease (IBD). IM is a critical outcome; however, difficulty in its prediction exists due to infrequent occurrence. We assessed IM predictors and developed a predictive model for IM using machine-learning (ML). Using the National Inpatient Sample (NIS) database (2005-2017), we extracted adults admitted for IBD. After ML-guided predictor selection, we trained and internally validated multiple algorithms, targeting minimum sensitivity and positive likelihood ratio (+LR)≥80% and ≥3, respectively. Diagnostic odds ratio (DOR) compared algorithm performance. The best performing algorithm was additionally trained and validated for an IBD-related surgery sub-cohort. External validation was done using NIS 2018. In 398426 adult IBD admissions, IM was 0.32% overall, and 0.87% among the surgical cohort (n=40784). Increasing age, ulcerative colitis, IBD-related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock and thromboembolism were associated with increased IM. The QLattice algorithm, provided the highest performance model (+LR: 3.2, 95% CI 3.0-3.3; area-under-curve [AUC]:0.87, 85% sensitivity, 73% specificity), distinguishing IM patients by 15.6-fold when comparing high to low-risk patients. The surgical cohort model (+LR: 8.5, AUC: 0.94, 85% sensitivity, 90% specificity), distinguished IM patients by 49-fold. Both models performed excellently in external validation. An online calculator (https://clinicalc.ai/im-ibd/) was developed allowing bedside model predictions. An online prediction-model calculator captured >80% IM cases during IBD-related admissions, with high discriminatory effectiveness. This allows for risk stratification and provides a basis for assessing interventions to reduce mortality in high-risk patients.

S1047 Decreased Hospitalization Costs and Charges in Cannabis Users With IBD

Introduction: The use of cannabis for symptom control in patients with inflammatory bowel disease (IBD) is common. Cannabis contains over 500 substances, several of which have exhibited anti-inflammatory properties in murine models. However, human clinical studies show conflicting data regarding its effects on IBD activity. The aim of this study was to examine and compare the clinical outcomes of cannabis users vs. cannabis non-users in admitted patients with IBD using a national database. Methods: Retrospective, observational study using the National Inpatient Sample (NIS) 2018. All patients with principal ICD10CM codes for IBD were included. The cohort was stratified into ulcerative colitis (UC) and Crohn’s disease (CD). Primary outcome was determining occurrence and odds of admission for IBD in patients with cannabis consumption compared to patients with no cannabis consumption. Secondary outcomes included inpatient morbidity, mortality, colectomy odds, hospital length of stay (LOS), and total hospital costs and charges. Multivariate regression analyses were used to adjust for confounding variables. Results: A total of 99,530 patient admissions for IBD were included in the study (39% UC), of who 3,095 (3.11%) had associated use of cannabis. Mean age was 36 years and 35% were female. A greater proportion of African Americans were noted to be cannabis users compared to non-cannabis users (26.44% vs 13.30%, respectively). Cannabis-users with CD were noted to have higher odds of admission (aOR:1.17, p< 0.01), while cannabis users with UC had lower odds of admission for IBD (aOR:0.80, p< 0.01) compared to non-cannabis users. Cannabis users with CD displayed lower odds of acute kidney injury (AKI) and multiorgan failure compared to non-cannabis users. Overall, cannabis users had decreased associated hospitalization costs and charges compared to non-cannabis users (Table). Conclusion: Cannabis users with UC displayed lower odds of admission compared to non-cannabis users. Although cannabis users with CD had higher odds of admission for IBD, these patients demonstrated lower odds of AKI and multiorgan failure. This may potentially suggest a lower degree of disease activity compared to non-cannabis users. This was also potentially reflected in the overall lesser hospitalization costs and charges. Future studies are needed to better assess inpatient outcomes of cannabis users with IBD, particularly focusing on disease activity. Table 1. - Adjusted Odds Ratios and Means for Cannabis Users with IBD Compared to Patients with Non-cannabis Users with IBD Adjusted Odds Ratio 95% Confidence Interval p-value IBD AdmissionCrohn's DiseaseUlcerative Colitis 1.031.170.80 0.97 - 1.141.05 - 1.300.68 - 0.94 0.48< 0.01< 0.01 MortalityCrohn's DiseaseUlcerative Colitis n/a n/a n/a ShockCrohn's DiseaseUlcerative Colitis 0.970.771.30 0.35-2.700.18-3.330.31-5.49 0.950.730.72 AKICrohn's DiseaseUlcerative Colitis 0.810.521.52 0.56-1.180.31-0.870.88-2.61 0.280.010.13 SIRSCrohn's DiseaseUlcerative Colitis 1.341.451.32 0.77-2.320.72-2.950.53-3.26 0.300.290.55 Multiorgan FailureCrohn's DiseaseUlcerative Colitis 0.760.481.42 0.53-1.110.29-0.820.83-2.45 0.16< 0.010.20 ColectomyCrohn's DiseaseUlcerative Colitis 0.670.750.56 0.45-1.000.46-1.230.27-1.17 0.060.270.13 No Cannabis Use Cannabis Use p-value Mean Costs (USD$)Crohn's DiseaseUlcerative Colitis $12,152$11,723$12,817 $11,033$11,052$10,984 < 0.01< 0.010.01 Mean Charges (USD$)Crohn's DiseaseUlcerative Colitis $49,610$47,612$52,710 $46,105$46,549$44,953 < 0.010.10< 0.01 Mean LOS (days)Crohn's DiseaseUlcerative Colitis 5.044.895.26 4.944.875.12 0.350.550.68 IBD - Inflammatory Bowel Disease, AKI - Acute Kidney Injury, SIRS - Systemic Inflammatory Response Syndrome, LOS - Length of Stay.

S813 Venous Thromboembolism Rates Among Patients Hospitalized for Inflammatory Bowel Disease Exacerbation: A Time Trend Analysis of the National Inpatient Sample

Introduction: Inflammatory bowel disease (IBD) flare increases risk of venous thromboembolism (VTE) events, especially during hospitalization. Guidelines, support the use of VTE prophylaxis for these patients, but it is unclear if this has impacted rates of VTE. Our goal was to assess time trends of VTE rates among IBD admissions. Methods: Patients hospitalized from 2007 to 2019 were identified in the National Inpatient Sample (NIS) by International Classification of Diseases (ICD), 9th and 10th Revision codes. Patients with IBD flare were selected by either a) a primary diagnosis of Crohn’s disease (CD) or Ulcerative colitis (UC) or b) a secondary diagnosis of CD or UC with a primary diagnosis of a gastrointestinal manifestations of IBD: abdominal pain, anemia, malnutrition, or dehydration. Hospitalizations for VTE were identified by those with a primary or secondary diagnosis of VTE. Patients with chronic thrombosis or prior VTE were excluded. Incidence of VTE was assessed by disease type (CD vs. UC) and by racial/ethnic identification: white, black, Hispanic, Asian or Pacific Islander, Native American, other. Cochran-Armitage trend tests were used for binary variables while trends for variables with reported mean averages used linear regression. The Rao-Scott design-adjusted chi-square test was used to evaluate the association between binary variables and the diagnosis of IBD in patients with VTE. Results: 131,541 weighted cases were admitted for an IBD flare complicated by VTE; 73,530 had CD and 58,011 had UC, Table. VTE prevalence was higher among patients with UC compared to CD, 42.6 vs. 30.7 per 1,000 hospitalizations, respectively. Over the study period, the rates of VTE in IBD hospitalizations increased, from 3.58% to 4.62% for UC (p< 0.0001) and from 2.22% to 3.66% for CD (p< 0.0001), Figure 1a. Black patients with IBD were found to be at higher risk of VTE (aOR 1.075, p=0.002), while Hispanic and Asian / Pacific Islanders had lower risk for developing VTE when compared to Whites (aOR 0.873 and 0.658, respectively; p< 0.0001). Aside from Hispanic and Native American UC patients, all races and ethnicities had increasing trends of VTE during the study period, Figure 1b, 1c. Conclusion: IBD admissions complicated by VTE have significantly increased. Though increasing awareness of VTE with IBD flare may have resulted in additional diagnoses, the study findings suggest that current VTE prophylaxis, or utilization of VTE prophylaxis, may be inadequate for those hospitalized for IBD flare.Figure 1.: VTE rates as % of total IBD hospitalizations per year. Table 1. - Patient Demographics and Hospital Characteristics of IBD Patients Admitted with VTE Variable Crohn's Disease (n=73,530) Ulcerative Colitis (n=58,011) Age in years [Mean(SD)] 56 (0.16) 60 (0.19) Sex Male 43.7% 50.3% Female 56.3% 49.7% Race* White 81.1% 79.6% Black 12.3% 10.4% Hispanic 3.8% 6.1% Asian / Pacific Islander 0.5% 1.1% Native American 0.4% 0.4% Other 1.9% 2.5% Insurance Type Medicare 48.5% 48.9% Medicaid 12.5% 8.8% Private Insurance 32.7% 36.4% Self-Pay 3.2% 2.8% Other 3.1% 3.1% Hospital Bed Size Small 13.8% 13.5% Medium 25.1% 24.8% Large 61.1% 61.7% Hospital Location/ Type Rural 7.2% 6.1% Urban Nonteaching 28.0% 28.9% Urban Teaching 64.8% 65.0% Charlson Comorbidity Index CCI = 0 36.4% 35.5% CCI = 1 21.8% 21.3% CCI = 2 15.5% 14.7% CCI ≥ 3 26.3% 28.6% Hospitalization Cost $95,500 $110,473 Length of Stay (in mean days) 10.39 11.25 Death (per 1,000 hospitalizations) 41.8 61.4 *There were some charts where race was documented in NIS as unknown.

S901 Rural versus Urban Differences in Inflammatory Bowel Disease (IBD) Hospitalizations: An Analysis of the National Inpatient Sample (NIS)

Introduction: Inflammatory bowel disease (IBD) is a significant cause of adult hospitalizations in the United States. There are fundamental differences in demographic distribution, socioeconomic status, access to care, and healthcare infrastructure between rural and urban areas in the US. However, very limited data evaluating these differences is available. The study aims to compare outcomes of IBD patients in these two different settings and explore the causes for any observed differences. Methods: Data obtained from the national inpatient sample (NIS) 2016–2019 database was evaluated for IBD admissions in rural and urban hospitals of the US. The primary outcome assessed was inpatient mortality, while secondary outcomes included odds of developing bowel perforation, septic shock, perianal disease, need for RBC transfusion, total hospital charges (THC), and length of stay (LOS). Results: A total of 348,469 adult IBD hospitalizations occurred during the study period. Out of this number, 24,044 patients were managed in rural settings, while 324,425 patients were managed in urban settings. The mean age of rural IBD patients was 48 years old while it was 44 years old in urban areas. Rural IBD patients had shorter inpatient LOS (3.94 days vs 5.03 days, p< 0.001) and THC ($24,515 vs $48,754, p< 0.001) than urban IBD patients. There was no difference between patient groups regarding inpatient mortality, developing septic shock, bowel perforation, need for RBC transfusion, and odds of developing perianal disease. Conclusion: The current study indicates most IBD care variables assessed between rural/urban settings were not different. However, differences were observed in LOS and THC between rural and urban IBD patients. The high cost of health care in urban settings most likely contributed to observed differences in the THC due to advanced treatments not being readily available in the rural environment. Increased access to subspecialist practices more comforTable with IBD patient care in urban areas also may contribute to a prolonged LOS as they likely deal with more medically complex patients who require advanced diagnostic testing not available at rural institutions. Improved understanding of rural/urban IBD patient severity variations and care access/availability are needed to accurately ascertain the reason behind these differences.

S950 Impact of Malnutrition on Resource Utilization in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis

Introduction: Malnutrition is a major complication of Inflammatory Bowel Disease (IBD), which is associated with poor clinical outcomes. The prevalence of malnutrition in IBD patients ranges from 18% to 85%, with a higher prevalence in hospitalized patients. Our study aimed to assess the prevalence of malnutrition in patients admitted with IBD and its influence on resource utilization in the US. Methods: National Inpatient Sample (NIS) for 2019 was queried using ICD-10-CM Codes to identify a cohort of inpatient IBD admissions with and without malnutrition. First, a weighted sample was used to get baseline characteristics and resource utilization (length of stay and total hospital charges) during the inpatient admissions. Then, multivariate linear regression analysis followed by predictive margins of the model was used to get adjusted estimates of the length of stay and total hospital charges. (Figure) Results: Among 92,740 patients hospitalized with IBD, 14420 (15.6%) patients had a concurrent diagnosis of malnutrition. Compared to males, there was less proportion of females having malnutrition (54.9% vs. 49.6%). Mean age was similar in IBD patients with and without malnutrition (47.4 years vs. 46.5 years). Compared to patients with malnutrition, there were larger proportions of patients with private insurance without malnutrition (45% vs. 48.4%). Malnutrition was associated with a significantly longer length of stay in IBD patients, 8.88 days (95% CI 8.52-9.24) vs. 4.23 days (95% CI 4.16-4.30) for patients without malnutrition in the adjusted model. Total hospital charges were also higher, $ 91392 (95% CI 83771-99014) with malnutrition vs. 44798$ (95% CI 42955-46640) for patients without malnutrition. Mortality was also higher in patients with malnutrition. (Table) Conclusion: Our study shows that malnutrition was quite prevalent in hospitalized IBD patients. It was associated with increased mortality in the hospitalized cohort and prolonged length of stay. In addition, it resulted in increased hospital charges. Early recognition and intervention can improve health outcomes for patients with IBD. Future studies should also assess predictors for developing malnutrition in this patient population.Figure 1.: IBD: Inflammatory Bowel Disease; IBD+Malnutrition: Inflammatory Bowel Disease with Malnutrition Table 1. - Adjusted for Age, Charlson Comorbidity Index, Hospital (Location, Teaching status, Bed Size), Insurance status Variables IBD without Malnutrition (78320) IBD with Malnutrition (14420) p-value a) Baseline Patient and Hospital Characteristics Age (SD) 46.5 (18.1) 47.4 (19.3) 0.03 Female (%) 43030 (54.9) 7150 (49.6) < 0.01 Race (%) 0.33 White 56745 (73.9) 10360 (73.8) Charlson Comorbidity Index (SD) 0.70 (1.3) 0.86 (1.5) < 0.01 Hospital Type (%) Urban 72735 (92.9) 13860 (96.1) < 0.01 Teaching 59765 (76.3) 12090 (83.8) < 0.01 Hospital Bed Size (Large) 39620 (50.6) 8575 (59.5) < 0.01 Payer Information (%) < 0.01 Medicare 20610 (27.4) 4405 (31.7) Private Insurance 36495 (48.4) 6250 (45.0) Disposition (%) < 0.01 Home AMADied 66595 (85.0)1955 (2.5)105 (0.1) 9550 (66.3)170 (1.2)165 (1.2) b) Resource Utilization LOS (Unadjusted) 4.19 (95% CI 4.11-4.26) 9.07 (95% CI 8.71-9.44) < 0.01 LOS (Adjusted) 4.23 (95% CI 4.16-4.30) 8.88 (95% CI 8.52-9.24) < 0.01 TOTAL CHARGES (Unadjusted) 44064 (95% CI 42229-45899) 94056 (95% CI 86272-101841) < 0.01 TOTAL CHARGES (Adjusted) 44798 (95% CI 42955-46640) 91392 (95% CI 83771-99014) < 0.01 IBD: Inflammatory Bowel Disease; SD: Standard Deviation; AMA: Against Medical Advice; LOS: Length Of Stay

Sources of excess steroid prescriptions and clinical adverse outcomes associated with steroid excess in patients with inflammatory bowel disease: The Leeds IBD Steroids study.

Corticosteroids remain important for managing inflammatory bowel disease (IBD) flares. Steroid excess, however, may be a marker of poor care. Patients access steroid prescriptions from primary (General Practitioners [GP]) or secondary care (hospital-based). Sources of prescriptions and associated outcomes are not well described. Patients attending IBD clinics with linked primary care information were included. We examined appropriateness and timeliness of treatment escalation and avoidability of steroid excess in relation to prescription sources. Of 2246 patients, 33% were exposed to steroids over 2 years. Primary care issued 28% of prescriptions. Secondary care prescriptions were more often of appropriate dose and duration (85% vs 41%, p< 0.001). Further flares occurred in 50% of patients prescribed steroids from primary care (vs 39%; p= 0.003). Steroid excess was observed in 15%. Patients with steroid excess who received prescriptions from primary care that were not communicated to secondary care less often received timely treatment escalation (49% vs 66%, p= 0.042) and steroid excess was more often avoidable (73% vs 56%, p= 0.022). Patients with steroid excess had higher risks of hospitalisation for IBD (OR=12.33, 95% CI [8.89-17.11]), hospitalisation for infections (OR=2.89, 95% CI [1.82-4.61]) and GP prescribed antibiotics (OR=1.41, 95% CI [1.07-1.86]). Patients commonly access steroids through primary care, but doses and durations are frequently inappropriate with patients more likely to flare. Steroid excess was associated with IBD admissions, admissions for infections and antibiotic prescriptions. Improved liaison between primary and secondary care is required to reduce steroid excess.

Impact of Cirrhosis on Outcomes in Inflammatory Bowel Disease Hospitalizations.

Evidence regarding outcomes in inflammatory bowel disease (IBD) hospitalizations with coexisting cirrhosis is scant. We queried the National Inpatient Sample (NIS) database to evaluate the impact of cirrhosis on hospitalization characteristics and outcomes in patients with Crohn's disease and ulcerative colitis. All admissions that listed IBD as a primary diagnosis by ICD-10-CM code (K50.X for Crohn's disease and K51.X for ulcerative colitis) in the NIS for 2016 and 2017 were included. Attributes of admissions with cirrhosis (K74.XX, 70.3, 78.81, and 71.7) were compared with noncirrhosis IBD admissions. The primary outcome was inpatient mortality. Length of stay and total hospital charges comprised secondary outcomes. A total weighted sample of 276,430 IBD admissions were identified, including 4615 with a concomitant diagnosis of cirrhosis. In a multivariate model, after adjusting for comorbidities, age, alimentary surgery during the admission and hospital type (teaching, urban nonteaching or rural), the presence of cirrhosis was associated with a higher inpatient mortality [odds ratio: 1.57; 95% confidence interval (CI): 1.16-2.15] and increased cost of admission (mean difference $11,651; 95% CI: 3830-19,472). No difference was noted in length of stay (difference: 0.44 d; 95% CI: -0.12-1.02) among these groups. Among admission diagnoses, infectious complications were the primary cause of death in 93.3% (95% CI: 87.1%-99.5%) of all inpatient mortality in the IBD with cirrhosis cohort as compared with 80.1% (95% CI: 77.6%-82.7%) of the mortality among IBD patients without cirrhosis ( P =0.01). This study demonstrates that the presence of cirrhosis has an independent negative impact on outcomes for hospitalized patients with IBD as reflected by increased in-hospital mortality and higher cost of admission. A majority of the mortality was attributable to infections.

Changes in admissions, and hospitalization outcomes of IBD patients in an Italian tertiary referral center over a 13-year period.

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center. Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed. Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions. Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

A Simple Emergency Department-Based Score Predicts Complex Hospitalization in Patients with Inflammatory Bowel Disease.

Thirty percent of inflammatory bowel disease (IBD) patients hospitalized with flare require salvage therapy or surgery. Additionally, 40% experience length of stay (LOS) > 7days. No emergency department (ED)-based indices exist to predict these adverse outcomes at admission for IBD flare. We examined whether clinical, laboratory, and endoscopic markers at presentation predicted prolonged LOS, inpatient colectomy, or salvage therapy in IBD patients admitted with flare. Patients with ulcerative colitis (UC) or colonic involvement of Crohn's disease (CD) hospitalized with flare and tested for Clostridioides difficile infection (CDI) between 2010 and 2020 at two urban academic centers were studied. The primary outcome was complex hospitalization, defined as: LOS > 7days, inpatient colectomy, or inpatient infliximab or cyclosporine. A nested k-fold cross-validation identified predictive factors of complex hospitalization. Of 164 IBD admissions, 34% (56) were complex. Predictive factors included: tachycardia in ED triage (odds ratio [OR] 3.35; confidence interval [CI] 1.79-4.91), hypotension in ED triage (3.45; 1.79-5.11), hypoalbuminemia at presentation (2.54; 1.15-3.93), CDI (2.62; 1.02-4.22), and endoscopic colitis (4.75; 1.75-5.15). An ED presentation score utilizing tachycardia and hypoalbuminemia predicted complex hospitalization (area under curve 0.744; CI 0.671-0.816). Forty-four of 48 (91.7%) patients with a presentation score of 0 (heart rate < 99 and albumin ≥ 3.4g/dL) had noncomplex hospitalization. Over 90% of IBD patients hospitalized with flare with an ED presentation score of 0 did not require salvage therapy, inpatient colectomy, or experience prolonged LOS. A simple ED-based score may provide prognosis at a juncture of uncertainty in patient care.

Declining Rates of Surgery for Inflammatory Bowel Disease in the Era of Biologic Therapy

BackgroundMedical therapy for inflammatory bowel disease (IBD) has markedly advanced since the introduction of biologic therapeutics, although surgery remains an important therapeutic strategy for both Crohn’s disease (CD) and ulcerative colitis (UC). This study evaluated how rates of bowel resection surgery and post-operative mortality for IBD have changed over the last decade in the era of biologic therapies. MethodsThe Nationwide Readmission Database (NRD) was queried for patients with IBD (based on ICD-9 and -10 diagnosis and procedure codes) who were hospitalized between 2010 and 2017. Longitudinal trends in bowel resection surgery, urgent surgery, and post-operative mortality were analyzed. ResultsDuring the 8-year period, a total of 1795,266 IBD-related hospitalizations (1,072,110 with CD and 723,156 with UC) were evaluated. There was an increase in the annual number of IBD patients hospitalized, but a statistically significant decrease in the proportion of IBD patients undergoing surgery, from 10 to 8.8% (p < 0.001) for CD and 7.7 to 7.5% (p < 0.001) for UC. From 2014 through 2017, the proportion of urgent surgeries remained stable around 25% (p = 0.16) for CD and decreased from 21 to 14% (p < 0.001) for UC. For CD, the rate of post-operative 30-day mortality varied between 1.2 and 1.6% and for UC decreased from 5.8 to 2.3% (p < 0.001). ConclusionsAnalysis of a nationwide dataset from 2010 to 2017 determined that despite an increase in total admissions for IBD, a smaller proportion of hospitalized patients underwent surgery. A greater proportion of surgeries for UC were performed on an elective basis, and overall the rates of post-operative mortality for CD and UC decreased. The growth of biologic medical therapy during the study period highlights a probable contributing factor for the observed changes.

S0729 All-Cause Hospitalization Rates Among IBD Patients in a Tertiary-Care Academic Hospital

INTRODUCTION: Studies have shown that the hospitalization rates for inflammatory bowel disease (IBD) patients in the United States have been increasing over the last decades despite advanced therapies. Some studies have investigated the reasons for inpatient admissions of IBD patients in specific populations, i.e. Veteran affair and pediatric hospitals, however few exist looking at hospitalization trends in general IBD patients in an academic hospital. METHODS: A list of IBD patients seen in outpatient clinics who were also hospitalized at Thomas Jefferson University Hospital from 11/01/2014 to 11/01/2019 was compiled. Via retrospective chart review, the data was analyzed for admission reason (IBD flare, IBD-related surgery/complication, IBD-related infection, or IBD-nonrelated). Average length of stay (LOS) for each reason was analyzed with ANOVA. Length of stay was also analyzed in ulcerative colitis (UC) admissions versus Crohn's disease (CD) and compared with t-test. The identified patients were then further divided by number of admissions (either 1, 2–3, or 3+) to characterize recurrent admissions. RESULTS: A total of 65 patients were identified for a total of 115 total admissions. The main reasons for admissions were found to be IBD flares (46.9%), IBD surgical procedures/surgical complications (20.0%), IBD-related infections (13.0%) and all other causes (20.0%). The average admission LOS was 5.0 ± 5.2 days, with LOS for specific reasons being: 4.7 ± 2.9 days for IBD flares, 4.4 ± 4.9 days for IBD surgeries/complications, 7.6 ± 10.5 days for IBD-related infections, and 4.5 ± 6.6 days for other causes. ANOVA revealed no statistical significance in LOS difference between all groups (P = 0.23). In total there were 94 CD admissions and 21 UC admissions, with an average LOS of 4.7 ± 4.9 days for CD and 6.3 ± 6.4 days for UC, but no significance on t-test (P = 0.10). 60.0% of patients had only 1 admission, 32.3% had 2-3, and 7.6% had 3+. CONCLUSION: High IBD admission rates cause a significant burden on healthcare costs. Our findings identified IBD admission trends in an academic center to understand why patients are being admitted, length of stay, and readmission rates. Studies from abroad have shown that interventions such as an IBD-patient-helpline reduce IBD-related admission rates. Given that majority of admissions are due to IBD complications with an average LOS of ∼5 days, future research would focus on a quality-improvement approach to reduce IBD-related admissions.Table 2.: This table shows the number of total Crohn's disease (CD) admissions and the total number of ulcerative colitis (UC) admissions for the 65 examined patients. The table also shows the average length of stay for each IBD sub-typeFigure 1.: This figure shows the percentage of number of admissions each patient with IBD has, and shows that majority (60%) have only 1 admission, but 40% have had re-admissions with nearly 8% having 3 or more admissions.Table 1.: This table shows reasons for admission, as well as the percentage of total admissions for that reason and the average length of stay (LOS) for each. IBD related infections had the longest LOS and the average total LOS for IBD admissions was 5 days

S0740 Economic Impact and Health-Care Utilization Trends Related to Hospitalization and Hospital Readmissions in Patients With Inflammatory Bowel Disease (IBD): A U.S. Population Cohort Study

INTRODUCTION: Hospitalization and readmissions (RAs) are considered poor quality outcomes in IBD patients (pts). However, the financial impact of RAs and predictors of this outcome are less well characterized in IBD. We hypothesized that since newer biologics have improved care of pts with IBD over the past years then there should be a beneficial impact on the cost of care, length of stay (LOS) and mortality during the index and RA hospitalization and reduction in 30-day RAs in pts with IBD. METHODS: This is a retrospective cohort study using the National Readmission Database (data on 17 million discharges each year in 27 states, accounting for 56% of all U.S. hospitalization). We identified pts admitted with IBD from 2010 to 2014 using ICD-9-CM codes. We excluded patients with age <18 yrs or who died during their index hospitalization or had elective RA. Trends of the total cost, LOS and in-hospital mortality was assessed in both the index and the RA hospitalization. Trend analysis was performed using the Cochrane Armitage Trend test. The cost was inflation-adjusted in reference to 2020. We also evaluated risk factors associated with 30-day hospital RA using multivariable logistic regression. RESULTS: The total number of index IBD admissions were 1,350,428, of which 234,216 (17.3%) were readmitted to the hospital within 30 days. From 2010 to 2014, 30-day RA trends remained stable at ∼17% (Figure 1A) and the in-hospital mortality trend in readmitted pts remained stable at 0.5%. (Figure 1B). While the mean LOS of the index hospitalization was stable at 5.5 days from 2010 to 2014 (Figure 2A), the aggregate cost of hospitalization decreased from 59 million to 55 million USD. There was a simultaneous rise in RA cost from 9.4 million to 12.5 million USD (Figure 2B). Table 1 shows the independent predictors of 30-days hospital RA. Younger age, male sex, longer index hospital LOS, higher comorbidities, the presence of VTE and C. diff infection during the index hospitalization were associated with an increased risk of 30-days RA. CONCLUSION: Despite the advent of new biologics and their widespread use, we found that the 30-day hospital RA rate, index and RA LOS and in-hospital mortality were unchanged in a nationwide cohort of IBD pts from 2010 to 2014, and interestingly the economic burden related to RA is increasing. We identified risk factors associated with 30-days RA. Pts at risk for RA need to be targeted during their index hospitalization in order to attempt to lessen the economic burden.Figure 1.: A) Trend of 30-day all-cause readmission B) Trend of 30-day inpatient mortality.Figure 2.: A) The trend of the length of stay on index hospitalization and following readmission B) The trend of aggregate cost of hospitalization on index hospitalization and following readmission.Table 1.: Factors associated with 30-day readmission in IBD patients

Trends in Anemia, Iron, Therapy, and Transfusion in Hospitalized Pediatric Patients with Inflammatory Bowel Disease

To evaluate trends in diagnosis and management of iron deficiency anemia using a large national children's hospital database in pediatric patients admitted with inflammatory bowel disease (IBD). In this retrospective multicenter cohort study, we used the Pediatric Health Information System de-identified administrative database. Patients age <21years with ≥2 admissions with International Classification of Disease, Ninth Revision and Tenth Revision codes for Crohn's disease or ulcerative colitis from 2012 to 2018 were included. We extracted data regarding diagnoses of anemia and/or iron deficiency, and receipt of oral iron, intravenous (IV) iron, and/or blood transfusion. Data were analyzed descriptively. We identified 8007 unique patients meeting study criteria for a total of 28 260 admissions. The median age at admission was 15.4years. A diagnosis of anemia was documented in 29.8% of admissions and iron studies were performed in 12.6%. IV iron was given in 6.3% of admissions and blood transfusions in 7.4%. The prevalence of the diagnosis of anemia among IBD admissions increased from 24.6% in 2012 to 32.4% in 2018 (P<.0001). There was a steady increase in the proportion of IBD admissions that used IV iron, from 3.5% in 2012 to 10.4% in 2018 (P<.0001), and the proportion of admissions with red cell transfusions decreased over time from 9.4% to 4.4% (P<.0001). Iron deficiency anemia is prevalent among pediatric patients with IBD admitted to US children's hospitals. From 2012 to 2018, there was an increase in the use of inpatient IV iron for the treatment of iron deficiency anemia and a decrease in transfusions.

Depression Predicts Prolonged Length of Hospital Stay in Pediatric Inflammatory Bowel Disease.

Few studies report the impact of depression on inflammatory bowel disease (IBD)-related hospitalizations. We evaluated the association between depression and pediatric IBD-related hospitalizations. Our primary aim was to test the hypothesis that depression is associated with hospital length of stay (LOS); our secondary goal was to evaluate if patients with depression are at higher risk for undergoing additional imaging and procedures. Data were extracted from the 2012 Kids Inpatient Database (KID), the largest nationally representative publicly available all-payer pediatric inpatient cross-sectional database in the United States. Hospitalizations for patients less than 21 years with a primary diagnosis Crohn disease (CD) or ulcerative colitis (UC) by ICD-9 code were included. Multivariable logistic regression was used to predict long LOS controlling for patient- and hospital-level variables and for potential disease confounders. For primary IBD-related hospitalizations (N = 8222), depression was associated with prolonged LOS (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.19-1.90) and total parenteral nutrition use (OR 1.54; 95% CI 1.04-2.27). Depression was not associated with increased likelihood of surgery (OR 0.97; 95% CI 0.72-1.30), endoscopy (OR 0.91; 95% CI 0.74-1.14), blood transfusion (OR 0.85; 95% CI 0.58-1.23), or abdominal imaging (OR 1.15; 95% CI 0.53-2.53). Depression is associated with prolonged LOS in pediatric patients with IBD, even when controlling for gastrointestinal disease severity. Future research evaluating the efficacy of standardized depression screening and early intervention may be beneficial to improving inpatient outcomes in this population.