title: Treatment of intra-abdominal abscesses in Crohn's disease: a nationwide analysis of patterns and outcomes of care.
abstract: BACKGROUND
  Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single-center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses.
  
  
  METHODS
  We identified all adult CD-related non-elective hospitalizations from the Nationwide Inpatient Sample 2007 that were complicated by an intra-abdominal abscess. Treatment modality was categorized into 3 strata-medical treatment alone, percutaneous drainage, and surgery. We analyzed the nationwide patterns in the treatment and outcomes of each treatment modality and examined for patient demographic, disease, or hospital-related disparities in treatment and outcome.
  
  
  RESULTS
  There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD. Approximately 39 % were treated by medical treatment alone, 29 % with percutaneous drainage, and 32 % with surgery with a significant increase in the use of percutaneous drainage since 1998 (7 %). Comorbidity burden, admission to a teaching hospital, and complicated Crohn's disease (fistulae, stricture) were associated with non-medical treatment. Use of percutaneous drainage was more common in teaching hospitals. Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days, respectively, and early intervention was associated with significantly shorter hospitalization.
  
  
  CONCLUSIONS
  We describe the nationwide pattern in the treatment of abdominal abscesses and demonstrate an increase in the use of percutaneous drainage for the treatment of this subgroup. Early treatment intervention was predictive of shorter hospitalization.
authors: Gastrointestinal Unit, Massachusetts General Hospital Crohn's and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. aananthakrishnan@partners.org
authors: Ashwin N
authors: AN
authors: Ananthakrishnan
authors: Emily L
authors: EL
authors: McGinley
mesh_terms: D018784:Abdominal Abscess / Q000191:economics / Q000209:etiology / Q000628:therapy*; D000328:Adult; D003424:Crohn Disease / Q000150:complications* / Q000191:economics; D016208:Databases, Factual; D004322:Drainage / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D057216:Propensity Score; D016896:Treatment Outcome; D014481:United States
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