title: Colectomy subtypes, follow-up surgical procedures, postsurgical complications, and medical charges among ulcerative colitis patients with private health insurance in the United States.
abstract: BACKGROUND
  We describe colectomy subtypes, follow-up surgical and diagnostic procedures, complications, and direct medical charges occurring within 180 days of colectomy among privately insured patients with ulcerative colitis (UC).
  
  
  METHODS
  This was a retrospective analysis of an insurance claims database for 2001-2005. We identified patients with a diagnosis of UC and no concurrent diagnosis of Crohn's disease who underwent colectomy. Colectomy types were classified as: 1) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), 2) subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileorectal anastomosis, 3) TPC with ileostomy, and 4) partial colectomy (PC). Follow-up surgical and diagnostic procedures and complications were collected. We developed estimates for UC-related charges for hospitalizations, outpatient visits, and medications for the time period 180 days before and after colectomy.
  
  
  RESULTS
  A total of 55,934 UC patients were identified, of whom 540 had a colectomy and at least 180 days of pre- and postcolectomy follow-up. The colectomy distribution was: TPC-IPAA, 44%; SC-ileostomy, 22%; TPC-ileostomy, 17%; and PC, 17%. Within 180 days after colectomy, 54% of patients had a second colectomy-related surgery, and 27% had a follow-up diagnostic procedure. Complications following colectomy for UC included: abscesses (11.5% early / 14.6% late), sepsis/pneumonia/bacteremia (9.3% early / 10.0% late), and fistulas (3.9% early / 8.3% late). The mean UC-related direct medical charge for the 180 days following and including initial colectomy was $90,445.
  
  
  CONCLUSIONS
  In this retrospective study of privately insured UC patients, we observed frequent follow-up surgical/diagnostic procedures, identified several complications postcolectomy, and estimated substantial charges 6 months pre- and postcolectomy.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA. loftus.edward@mayo.edu
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Howard S
authors.initials: HS
authors.lastname: Friedman
authors.forename: David J
authors.initials: DJ
authors.lastname: Delgado
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
mesh_terms: D000328:Adult; D003082:Colectomy / Q000191:economics / Q000706:statistics & numerical data*; D003093:Colitis, Ulcerative / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D039021:Colonic Pouches / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005102:Health Expenditures / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007081:Ileostomy / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010030:Ostomy / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology