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

• Published in: Journal of gastrointestinal surgery Vol. 24; no. 2; pp. 270 - 277
• Main Authors: Ghoz, Hassan, Kesler, Alex, Hoogenboom, Sanne A., Gavi, Filippo, Brahmbhatt, Bhaumik, Cangemi, John, Kröner, Paul T.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2020; Springer Nature B.V
• Subjects: Case-Control Studies; Colectomy - statistics & numerical data; Colitis, Ulcerative - economics; Colitis, Ulcerative - surgery; Disease control; Female; Gastroenterology; Health care expenditures; Hospital Costs; Hospitalization; Humans; Inflammatory bowel disease; Length of Stay - economics; Length of Stay - trends; Male; Medicine; Medicine & Public Health; Middle Aged; Retrospective Studies; SSAT Plenary Presentation; Surgery; Trends; Inflammatory bowel disease; Hospital admissions; Healthcare costs; Inpatient epidemiology
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04474-9

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.