title: Rising post-colectomy complications in children with ulcerative colitis despite stable colectomy rates in United States.
abstract: OBJECTIVE
  In children with ulcerative colitis, data on temporal colectomy trends and in-hospital post-colectomy complications are limited. Thus, we evaluated time trends in colectomy rates and post-colectomy complications in children with ulcerative colitis.
  
  
  METHODS
  We identified all children (≤18years) with a diagnosis code of ulcerative colitis (ICD-9: 556.X) and a procedure code of colectomy (ICD-9: 45.8 and 45.7) in the Kids' Inpatient Database for 1997, 2000, 2003, 2006 and 2009. The incidence of colectomies for pediatric ulcerative colitis was calculated and Poisson regression analysis was performed to evaluate the change in colectomy rates. In-hospital postoperative complication rates were assessed and predictors for postoperative complications were evaluated using multivariate logistic regression.
  
  
  RESULTS
  The annual colectomy rate in pediatric ulcerative colitis was 0.43 per 100,000person-years, which was stable throughout the study period (P>.05). Postoperative complications were experienced in 25%, with gastrointestinal (13%) and infectious (9.3%) being the most common. Postoperative complication rates increased significantly by an annual rate of 1.1% from 1997 to 2009 (P=.01). However, other independent predictors of postoperative complications were not identified. Patients with postoperative complications had significantly longer median length of stay (14.3days vs 8.2days; P<.001) and higher median hospital charges per patient (US $81,567 vs US $55,461; P<.001) compared to those without complications.
  
  
  CONCLUSIONS
  Colectomy rates across the United States in children with ulcerative colitis have remained stable between 1997 and 2009; however, in-hospital postoperative complication rates have increased.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Ing Shian
authors.initials: IS
authors.lastname: Soon
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Canada.
authors.forename: Jennifer C C
authors.initials: JC
authors.lastname: deBruyn
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Hubbard
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Canada.
authors.forename: Iwona
authors.initials: I
authors.lastname: Wrobel
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Paediatrics, University of Calgary, Calgary, Canada.
authors.forename: Reg
authors.initials: R
authors.lastname: Sauve
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: David L
authors.initials: DL
authors.lastname: Sigalet
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary, Calgary, Canada. Electronic address: ggkaplan@ucalgary.ca.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects* / Q000706:statistics & numerical data* / Q000639:trends; D003093:Colitis, Ulcerative / Q000601:surgery*; D004630:Emergencies; D005260:Female; D017722:Hospital Charges; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D007902:Length of Stay; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Children; Colectomy; Kids' Inpatient Database; Postoperative complications; Ulcerative colitis