SHIFTS IN USE OF COLECTOMY IN PATIENTS WITH CROHN'S DISEASE THROUGHOUT THE PAST DECADE
Paul T. Kroner*, Alex M. Kesler, Peter Abader, Mohammad Afsh, Victor Ciofoaia, John R. Cangemi
Mayo Clinic Florida, Jacksonville, FL
Introduction
Patients with Crohn's disease (CD) undergoing colectomy display elevated risk of anastomotic surgical recurrence. The management of CD has dramatically evolved in the past decade, with the advent of better immunotherapeutics and biologic medications. This has resulted in improved rates of disease control, which theoretically could translate into patients requiring less surgical management. The aim of this study is to examine the trend of colectomies in patients with CD over the past decade.
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 CD were included. None were excluded. The primary outcome was determining the temporal trends in the use of colectomy in patients with CD. Secondary outcomes were determining the 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 759,609 patients with Crohn's disease were identified, of which 37,319 (4.9%) underwent colectomy. The mean patient age was 44 years, and 53% were female. For the primary outcome, colectomy in patients with Crohn's disease decreased from 5.1% in 2007 to 3.5% in 2016. This was confirmed on the multivariate model, as patients with CD had an adjusted odds ratio of 0.68 (p<0.01) of undergoing colectomy in 2016 compared to 2007. When stratifying for type of colectomy, the proportion of right-sided colectomies decreased, while the proportion of left-sided and total colectomies increased. For secondary outcomes, patients with Crohn's disease had increased additional adjusted hospital costs of $2,451 (p=0.05), while also increased additional adjusted hospital charges $33,888 (p<0.01). No other differences were noted. All outcomes are displayed in Tables 1 and 2.
Conclusion
The use of colectomy in patients with Crohn's disease is decreasing, particularly in the past 3 years. This could represent both an increased availability of novel pharmacological options with the improvement of biologic medications, as well as a shift away from surgery given the elevated incidence of recurrent disease at the surgical sites. Continued research should focus on improvement of immune-modulating therapy for better disease control, as well as potentially optimized low surgical recurrence surgical (e.g. Kono-S anastomosis) in patients who eventually require surgery.
Table 1
| Variable | 2007 | 2010 | 2013 | 2016 | p-value |
| Total Colectomies Percentage | 8,055 5.1% | 11,079 5.7% | 10,740 5.5% | 7,265 3.5% | <0.01 |
| Subcategories Right Colectomy Left Colectomy Total Colectomy Proctectomy | 72.1% 14.6% 4.1% 9.2% | 68.6% 13.1% 9.0% 9.3% | 69.2% 12.7% 8.0% 10.1% | 61.4% 18.1% 11.4% 9.1% | <0.01 |
Crude number of total colectomies stratified by percentage of type, comparing 2007 to 2010, 2013, and 2016
Table 2
| aOR (95% CI), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| Colectomy | 1.13 (0.99 -1.28), 0.08 | 1.08 (0.97 - 0.12), 0.14 | 0.68 (0.61-0.76), <0.01 |
| aMean (95% CI), p-value | |||
| Variable | 2010 | 2013 | 2016 |
| Additional Costs | $1,390 (-788 - 3569), 0.21 | $808 (-1098 - 2714), 0.41 | $2,451 (-14 - 4917), 0.05 |
| Additional Charges | $14,069 (5175 - 22963), <0.01 | $21,845 (13154 - 30537), <0.01 | $33,888 (23,766 - 44011), <0.01 |
| Additional LOS | -0.13(-0.79 - 0.53), 0.70 | -0.61 (-1.27 - 0.53), 0.07 | -0.59 (-1.39 - 0.22), 0.15 |
Adjusted odds and additional adjusted means for patients with Crohn's disease undergoing colectomy compared to patients with Crohn's disease that did not undergo colectomy.
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