DECLINING RATES OF EMERGENT SURGERY FOR INFLAMMATORY BOWEL DISEASE IN THE ERA OF BIOLOGIC THERAPY
Sarina C. Lowe*, Jenny Sauk, Berkeley N. Limketkai, Mary Kwaan
University of California, Los Angeles (UCLA), Los Angeles, CA
Background: Despite the increasing use of biologic therapy over the past two decades, surgery remains a mainstay of therapy for inflammatory bowel disease (IBD). However, the data are unclear as to whether surgical rates in Crohn’s disease (CD) or ulcerative colitis (UC), and post-operative mortality rates have changed over the last decade in the era of biologics. The present study seeks to further investigate the efficacy of biologic therapy by evaluating national trends in IBD-associated surgical rates and post-operative mortality between 2010 and 2016.
Methods: The Nationwide Readmission Database (NRD) constitutes 17 million all-payer hospital inpatient stays from 27 state inpatient databases. The database was queried for patients with CD or UC at the time of their index hospitalization or IBD-related resection (colectomy or small bowel resection) between 2010 and 2016. Inclusion in queries was based on ICD-9 and ICD-10 diagnosis and procedure codes. Trends over time for rates of bowel resection and post-operative mortality were evaluated and risk factors for post-op mortality were analyzed using multivariable Cox regression.
Results: There were 932,257 patients hospitalized with CD and 626,564 with UC between 2010 and 2016. Bowel resections were performed during 7.7% of CD-related and 7.1% of UC-related hospitalizations. Over the study period, the proportion of hospitalized CD patients undergoing surgery decreased from 8.8% to 7.3% (p<0.01) and from 8.0% to 7.3% for UC patients (p<0.01). The proportion of urgent/emergent surgeries (surgery within 2 days of non-elective admission) also decreased from 43% to 21% for CD (p<0.01) and 39% to 16% for UC (p<0.01). Post-operative 30-day mortality in UC patients dropped from 5.2 to 2.5% (p<0.01) but remained stable in CD patients from 1% to 1.4% (p=0.46). Multivariable analysis showed older age, higher Charlson comorbidity index, lower income, and non-elective admission to be individual predictors of post-op mortality for UC and CD, while malnutrition was an additional predictor for post-op mortality in CD.
Conclusions: Using the NRD data, rates of bowel resection and urgent/emergent surgery have significantly declined in both UC and CD patients between 2010 and 2016. This trend may be related to advances in medical therapy. Post-operative 30-day mortality has declined in UC, but not CD, although overall post-op mortality still remains higher in UC than CD.
Table 1. Multivariable Cox proportional hazard analysis of post-op mortality.
Figure 1. Trends in rates of urgent/emergent surgery for Crohn's disease (p<0.01) and ulcerative colitis (p<0.01).
Back to 2020 Abstracts