title: The impact of perianal disease in young patients with inflammatory bowel disease.
abstract: BACKGROUND
  Perianal disease is a potentially significant source of morbidity for patients with inflammatory bowel disease (IBD). We sought to identify the impact of perianal disease on IBD outcomes in children, adolescents, and young adults.
  
  
  METHODS
  We studied 12,465 inpatient admissions for patients ≤20 years old with IBD in 2009 using the Kids' Inpatient Database (KID). Patients were stratified by their principal diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). Perianal disease (perianal abscess, anal fissure, or anal fistula), complex fistulas (rectourethral, rectovaginal, or enterovesical), and growth failure were defined by ICD-9 codes. Logistic regression was performed adjusting for CD or UC, gender, age, need for surgical intervention, fistulas, or growth failure.
  
  
  RESULTS
  Of the 511 (4.1%) patients with perianal disease, 480 had CD (94%, p < 0.001). Girls were less likely to suffer perianal disease (OR = 0.63, CI 0.52-0.76, p < 0.001). Those with perianal disease were more likely to suffer complex fistulas (OR = 3.5, CI 1.98-6.20, p < 0.001) but less likely to suffer enteroenteral fistulas (OR = 0.30, CI 0.15-0.63, p = 0.001) than those without perianal disease. Perianal disease did not increase the incidence of growth failure (p = 0.997) but doubled the likelihood of an operation of any type during admission (p < 0.001). Additionally, patients with perianal disease spent on average 1.29 more days in the hospital (7.45 vs. 6.16 days, p < 0.001) and accrued $5838 extra in hospital charges (p = 0.005).
  
  
  CONCLUSIONS
  Perianal disease in younger patients is associated with a longer length of stay, higher hospital charges, and increased rates of both perineal and abdominal operative procedures. These data support the notion that, similar to adults, the presence of perianal disease in pediatric Crohn's patients is associated with a more severe course.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA, 98431, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Zwintscher
authors.forename: Puja M
authors.initials: PM
authors.lastname: Shah
authors.forename: Amit
authors.initials: A
authors.lastname: Argawal
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Chesley
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Newton
authors.forename: Justin A
authors.initials: JA
authors.lastname: Maykel
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000038:Abscess / Q000191:economics / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D001004:Anus Diseases / Q000191:economics / Q000209:etiology* / Q000601:surgery; D002648:Child; D003093:Colitis, Ulcerative / Q000150:complications* / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D017577:Cutaneous Fistula / Q000191:economics / Q000209:etiology* / Q000601:surgery; D005260:Female; D005401:Fissure in Ano / Q000191:economics / Q000209:etiology / Q000601:surgery; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D012003:Rectal Fistula / Q000191:economics / Q000209:etiology* / Q000601:surgery; D012737:Sex Factors; D055815:Young Adult