SSAT - Emergency Department Presentation, Admission and Surgical Intervention for Crohn's Disease and Ulcerative Colitis in the United States

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Emergency Department Presentation, Admission and Surgical Intervention for Crohn's Disease and Ulcerative Colitis in the United States
Keri Calkins^*², Aparajita Singh³, Joseph K. Canner², ERIC B. SCHNEIDER^1,2
¹Surgery, Brigham and Women's Hospital / Center for Surgery and Public Health, Boston, MA; ²Surgery, Johns Hopkins School of Medicine, Baltimore, MD; ³Gastroenterology, University of California, San Francisco, San Francisco, CA

Introduction: Patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) experience substantial morbidity. We examined patterns of emergency department (ED) visits, admission, and surgery in these patients.
Methods: The 2006-2011 Nationwide Emergency Department Sample was used to examine trends in admission, surgery, and in-hospital mortality among ED patients presenting with CD or UC.
Results: A total of 1,554,382 ED visits for CD and 583,288 for UC occurred between 2006-2011. Among CD patients, 59% were female and 15% were over 65, whereas 55% of UC patients were female and 30% were 65 or older. Among CD patients, 44% were admitted, 5% underwent endoscopy, and 3% underwent surgery; whereas 66% of all UC patients were admitted, 9% underwent endoscopy, and 4% underwent surgery. Patients over age 65 in both groups demonstrated higher odds of admission compared to those under age 40 (OR=4.12 [3.89,4.37] for CD, OR=3.86 [3.54,4.22] for UC). Among admitted CD patients, the odds of surgery were lower in the older age groups compared with those under the age of 40 (OR_40to65=0.71 [0.68,0.75], OR₆₅₊=0.78 [0.72,0.85]); however, the odds of surgery among UC patients were greater among those over 40 (OR_40to65=1.44 [1.32,1.59], OR₆₅₊=1.47 [1.30,1.65]); however, among CD patients (all ORs adjust for sex and primary payer). Less than 0.01% of CD patients and approximately 2% of UC patients died in hospital. From 2006-2011, the number of patients presenting for ED care with CD increased by 63%; however, the proportion of individuals admitted to inpatient status decreased from 51% to 42% for CD and 71% to 62% for UC patients.
Discussion: A substantial proportion of individuals presenting for ED treatment of CD and UC were admitted to the hospital; however, proportionally fewer patients were admitted across time. Older UC patients were more likely, and older CD patients were less likely, to undergo surgical intervention than their younger counterparts.

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