DECREASING COLECTOMY RATES IN ULCERATIVE COLITIS IN THE PAST DECADE: IMPROVED DISEASE CONTROL?
Paul T. Kroner*, Alex M. Kesler, Peter Abader, Mohammad Afsh, Bhaumik Brahmbhatt, John R. Cangemi
Mayo Clinic Florida, Jacksonville, FL
Introduction
Ulcerative colitis (UC) is primarily medically managed, but colectomy is required in patients with refractory disease or severe complications such as perforation. Older studies have reported 20-year colectomy rates of over 50%, but more recent studies have seen 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. Hence, the aim of our study is to assess the trend in inpatient rates of colectomy in patients with UC over the past decade, along with resource utilization.
Methods
Case-control study using the NIS 2007, 2010, 2013 and 2016, the largest public inpatient database in the US. All patients with ICD10CM codes for UC were included. None were excluded. 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, determining associated trend in additional inflation-adjusted hospital costs, charge and length of hospital stay (LOS) in patients undergoing colectomy for CD in the past decade. Multivariate regression analyses were used to adjust for gender, age, Charlson Comorbidity Index, income in patient zip code, hospital region, location, size and teaching status.
Results
A total of 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. For the primary outcome, 5.0% 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 inpatients in the study period. This was confirmed on multivariate analysis, with patients with UC displaying adjusted odds of colectomy of 0.51 (p<0.01) in 2016 compared to 2007. For secondary outcomes, the adjusted additional mean hospital costs decreased by -$2,898 (p<0.01), additional total hospital charges increased by $26,554 (p<0.01), and additional length of stay decreased by -2.2 days (p<0.01) in 2016 compared to 2007. Adjusted odds and means are shown in Table 1.
Conclusion
The odds of colectomy in patients with UC have decreased significantly over the past decade, corroborating recent studies' findings that colectomy rates in UC are now much lower than previously thought. This certainly reflects the better disease activity control that has been achieved with newer and improved biologics. Interestingly, over the past decade more patients with UC are being admitted to the hospital, which could reflect an increased number of overall cases given better diagnostic modalities that have become available, or possible immunosuppressing complications of biologic medications.
Adjusted odds ratios and means for evaluated parameters in patients with ulcerative colitis admitted to the hospital in the years 2016, 2013 and 2010 compared to patients with ulcerative colitis admitted during 2007.
| Adjusted Odds Ratio, (95% Confidence Interval), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| Ulcerative Colitis | 1.28 (1.21-1.36), <0.01 | 1.42(1.35-1.49), <0.01 | 1.56(1.49-1.63), <0.01 |
| Colectomy | 1.01(0.86-1.18), 0.91 | 0.97(0.84-1.12), 0.64 | 0.51(0.44-0.60), <0.01 |
| Adjusted Mean (95% Confidence Interval), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| Additional Costs | $5,055 (1505-13209),p<0.01 | $2,891 (-558-4250), p=0.08 | -$2,898 (-5384 - -1320), p<0.01 |
| Additional Charges | $27,923 (10958-48587), p<0.01 | $34,996 (21348-45848), p<0.01 | $26,554 (16247-31874), p<0.01 |
| Additional Length of Stay (days) | 0.3 (-0.2 - 2.5), p=0.15 | -0.7 (-1.8 - -0.1), p=0.04 | -2.2 (-3.3 - -1.4), p<0.01 |
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