A nationwide analysis of changes in severity and outcomes of inflammatory bowel disease hospitalizations.
BACKGROUND
The past decade has seen a change in inflammatory bowel disease (IBD; Crohn's disease (CD) and ulcerative colitis (UC)) treatment, with increasing use of immunomodulators and biologics. The impact of this on IBD hospitalization outcomes is unknown.


METHODS
We identified hospitalizations with a diagnosis of IBD using data from the Nationwide Inpatient Sample, a national US discharge database. We compared the proportion of hospitalizations resulting in surgery in the entire cohort and within each disease severity stratum for the years 1998, 2004, and 2007.


RESULTS
There were an estimated 89,673 hospitalizations for CD in 1998 increasing to 150,593 hospitalizations in 2007. UC hospitalizations increased from 56,911 in 1998 to 86,611 in 2007. This increase was primarily among low or intermediate severity hospitalizations not requiring surgery. For CD, the proportion of bowel surgeries during hospitalization decreased from 17.3% in 1998 to 12.4% in 2007 (p < 0.001) while for UC, the proportion of colectomy decreased from 9.5% in 1998 to 6.2% in 2007 (p < 0.001). For both diagnoses, this reduction was significant in those with a low severity of disease but not with in those with the highest severity stratum.


CONCLUSIONS
There continues to be an increase in the number of hospitalizations in patients with IBD. The numbers of non-elective bowel surgeries among those with the highest severity of disease continues to increase suggesting need for further research into improving outcomes in this cohort at high risk for adverse outcome.
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, USA. aananthakrishnan@partners.org
Ashwin N
AN
Ananthakrishnan
Emily L
EL
McGinley
David G
DG
Binion
Kia
K
Saeian
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000706:statistics & numerical data* / Q000639:trends; D003093:Colitis, Ulcerative / Q000150:complications / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index; D014481:United States