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Erschienen in: Journal of Gastrointestinal Surgery 2/2020

03.12.2019 | SSAT Plenary Presentation

Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control?

verfasst von: Hassan Ghoz, Alex Kesler, Sanne A. Hoogenboom, Filippo Gavi, Bhaumik Brahmbhatt, John Cangemi, Paul T. Kröner

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 2/2020

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Abstract

Background

Ulcerative colitis (UC) is primarily medically managed. Colectomy is required in patients with refractory disease or severe complications. Older studies have reported 20-year colectomy rates of over 50%, but recent studies showed decreased rates to 15%. Temporal trends in the use of colectomy in UC over the past decade (when the use of biologics has become widespread) are lacking.

Methods

Case-control study using the National Inpatient Sample database for years of 2007, 2010, 2013, and 2016 was performed. The primary outcome was determining the temporal trends in the use of colectomy in hospitalized patients with UC. Secondary outcomes were determining the total number of admissions for patients with UC and associated trend in inflation-adjusted hospital costs, charge, and length of hospital stay (LOS). Multivariate regression analyses were used to adjust for other co-variables.

Results

443,043 patients with UC were identified, of which 19,208 underwent colectomy in the study period. The mean patient age was 52 years, and 47% were female. Five percent of hospitalized patients with UC underwent colectomy in 2007, while 2.7% of patients with UC had colectomy in 2016, representing a 46% decrease in colectomies in hospitalized patients in the study period. Patients with UC displayed adjusted odds of colectomy of 0.51 (p < 0.01), adjusted additional mean hospital costs decrease by − $2898 (p < 0.01), hospital charges increase by $26,554 (p < 0.01), LOS decrease by − 2.2 days (p < 0.01) in 2016 compared to 2007.

Conclusion

The odds of colectomy in UC patients decreased significantly over the past decade, likely secondary to improved medical care.
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Literatur
1.
Zurück zum Zitat Ng, S.C., et al., Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet, 2018. 390(10114): p. 2769–2778.CrossRef Ng, S.C., et al., Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet, 2018. 390(10114): p. 2769–2778.CrossRef
2.
Zurück zum Zitat Baumgart, D.C. and S.R. Carding, Inflammatory bowel disease: cause and immunobiology. Lancet, 2007. 369(9573): p. 1627–40.CrossRef Baumgart, D.C. and S.R. Carding, Inflammatory bowel disease: cause and immunobiology. Lancet, 2007. 369(9573): p. 1627–40.CrossRef
3.
Zurück zum Zitat Loftus, C.G., et al., Update on the incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940-2000. Inflammatory bowel diseases, 2007. 13(3): p. 254–61.CrossRef Loftus, C.G., et al., Update on the incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940-2000. Inflammatory bowel diseases, 2007. 13(3): p. 254–61.CrossRef
4.
Zurück zum Zitat Langholz, E., et al., Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology, 1994. 107(1): p. 3–11.CrossRef Langholz, E., et al., Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology, 1994. 107(1): p. 3–11.CrossRef
5.
Zurück zum Zitat Jani, N. and M.D. Regueiro, Medical therapy for ulcerative colitis. Gastroenterology clinics of North America, 2002. 31(1): p. 147–66.CrossRef Jani, N. and M.D. Regueiro, Medical therapy for ulcerative colitis. Gastroenterology clinics of North America, 2002. 31(1): p. 147–66.CrossRef
6.
Zurück zum Zitat Cima, R.R. and J.H. Pemberton, Medical and Surgical Management of Chronic Ulcerative Colitis. JAMA Surgery, 2005. 140(3): p. 300–310. Cima, R.R. and J.H. Pemberton, Medical and Surgical Management of Chronic Ulcerative Colitis. JAMA Surgery, 2005. 140(3): p. 300–310.
7.
Zurück zum Zitat Leijonmarck, C.E., P.G. Persson, and G. Hellers, Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study. Gut, 1990. 31(3): p. 329–33.CrossRef Leijonmarck, C.E., P.G. Persson, and G. Hellers, Factors affecting colectomy rate in ulcerative colitis: an epidemiologic study. Gut, 1990. 31(3): p. 329–33.CrossRef
8.
Zurück zum Zitat Farmer, R.G., K.A. Easley, and G.B. Rankin, Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of 1116 patients. Digestive diseases and sciences, 1993. 38(6): p. 1137–46.CrossRef Farmer, R.G., K.A. Easley, and G.B. Rankin, Clinical patterns, natural history, and progression of ulcerative colitis. A long-term follow-up of 1116 patients. Digestive diseases and sciences, 1993. 38(6): p. 1137–46.CrossRef
9.
Zurück zum Zitat Ko, C.W., et al., AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology, 2019. 156(3): p. 748–764.CrossRef Ko, C.W., et al., AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology, 2019. 156(3): p. 748–764.CrossRef
10.
Zurück zum Zitat Øresland, T., et al., European evidence based consensus on surgery for ulcerative colitis. Journal of Crohn's and Colitis, 2014. 9(1): p. 4–25.CrossRef Øresland, T., et al., European evidence based consensus on surgery for ulcerative colitis. Journal of Crohn's and Colitis, 2014. 9(1): p. 4–25.CrossRef
11.
Zurück zum Zitat Thorne, K., et al., Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review. European journal of gastroenterology & hepatology, 2016. 28(4): p. 369–82.CrossRef Thorne, K., et al., Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review. European journal of gastroenterology & hepatology, 2016. 28(4): p. 369–82.CrossRef
12.
Zurück zum Zitat Parragi, L., et al., Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-year Follow-up Data From the Swiss IBD Cohort Study. Journal of Crohn's & colitis, 2018. 12(7): p. 811–818.CrossRef Parragi, L., et al., Colectomy Rates in Ulcerative Colitis are Low and Decreasing: 10-year Follow-up Data From the Swiss IBD Cohort Study. Journal of Crohn's & colitis, 2018. 12(7): p. 811–818.CrossRef
13.
Zurück zum Zitat Murthy, S.K., et al., High end of life health care costs and hospitalization burden in inflammatory bowel disease patients: A population-based study. PloS one, 2017. 12(5): p. e0177211.CrossRef Murthy, S.K., et al., High end of life health care costs and hospitalization burden in inflammatory bowel disease patients: A population-based study. PloS one, 2017. 12(5): p. e0177211.CrossRef
14.
Zurück zum Zitat Khera, R. and H.M. Krumholz, With Great Power Comes Great Responsibility: Big Data Research From the National Inpatient Sample. Circulation. Cardiovascular quality and outcomes, 2017. 10(7): p. e003846. Khera, R. and H.M. Krumholz, With Great Power Comes Great Responsibility: Big Data Research From the National Inpatient Sample. Circulation. Cardiovascular quality and outcomes, 2017. 10(7): p. e003846.
15.
Zurück zum Zitat Deyo, R.A., D.C. Cherkin, and M.A. Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992. 45(6): p. 613–9.CrossRef Deyo, R.A., D.C. Cherkin, and M.A. Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 1992. 45(6): p. 613–9.CrossRef
16.
Zurück zum Zitat Bewtra, M., C. Su, and J.D. Lewis, Trends in Hospitalization Rates for Inflammatory Bowel Disease in the United States. Clinical Gastroenterology and Hepatology, 2007. 5(5): p. 597–601.e1.CrossRef Bewtra, M., C. Su, and J.D. Lewis, Trends in Hospitalization Rates for Inflammatory Bowel Disease in the United States. Clinical Gastroenterology and Hepatology, 2007. 5(5): p. 597–601.e1.CrossRef
17.
Zurück zum Zitat Smyth, C.M., et al., Increasing rates and changing patterns of hospital admissions for patients with inflammatory bowel disease in Ireland: 1996–2001. Irish Journal of Medical Science, 2005. 174(4): p. 28.CrossRef Smyth, C.M., et al., Increasing rates and changing patterns of hospital admissions for patients with inflammatory bowel disease in Ireland: 1996–2001. Irish Journal of Medical Science, 2005. 174(4): p. 28.CrossRef
18.
Zurück zum Zitat Rawla, P. and T. Sunkara, Trends of Hospitalization in Ulcerative Colitis in Patients in the United States from 2000-2014. Conference poster presented at Advances in Inflammotory Bowel Diseases 2018, Orlando, Florida. Rawla, P. and T. Sunkara, Trends of Hospitalization in Ulcerative Colitis in Patients in the United States from 2000-2014. Conference poster presented at Advances in Inflammotory Bowel Diseases 2018, Orlando, Florida.
19.
Zurück zum Zitat Dias, C.C., et al., Hospitalization trends of the Inflammatory Bowel Disease landscape: A nationwide overview of 16 years. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2019. 51(7): p. 952–960.CrossRef Dias, C.C., et al., Hospitalization trends of the Inflammatory Bowel Disease landscape: A nationwide overview of 16 years. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2019. 51(7): p. 952–960.CrossRef
20.
Zurück zum Zitat Askling, J., et al., Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. Annals of the rheumatic diseases, 2007. 66(10): p. 1339–44.CrossRef Askling, J., et al., Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. Annals of the rheumatic diseases, 2007. 66(10): p. 1339–44.CrossRef
21.
Zurück zum Zitat Kaplan, G.G., et al., Decreasing colectomy rates for ulcerative colitis: a population-based time trend study. The American journal of gastroenterology, 2012. 107(12): p. 1879–87.CrossRef Kaplan, G.G., et al., Decreasing colectomy rates for ulcerative colitis: a population-based time trend study. The American journal of gastroenterology, 2012. 107(12): p. 1879–87.CrossRef
22.
Zurück zum Zitat Xu, F., et al., Trends and Factors Associated with Hospitalization Costs for Inflammatory Bowel Disease in the United States. Applied health economics and health policy, 2019. 17(1): p. 77–91.CrossRef Xu, F., et al., Trends and Factors Associated with Hospitalization Costs for Inflammatory Bowel Disease in the United States. Applied health economics and health policy, 2019. 17(1): p. 77–91.CrossRef
23.
Zurück zum Zitat Klabunde, C.N., J.L. Warren, and J.M. Legler, Assessing comorbidity using claims data: an overview. Med Care, 2002. 40(8 Suppl): p. Iv-26-35. Klabunde, C.N., J.L. Warren, and J.M. Legler, Assessing comorbidity using claims data: an overview. Med Care, 2002. 40(8 Suppl): p. Iv-26-35.
Metadaten
Titel
Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control?
verfasst von
Hassan Ghoz
Alex Kesler
Sanne A. Hoogenboom
Filippo Gavi
Bhaumik Brahmbhatt
John Cangemi
Paul T. Kröner
Publikationsdatum
03.12.2019
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 2/2020
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-019-04474-9

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