title: Hospital Burden and Gastrointestinal Surgery in Inflammatory Bowel Disease Patients in Italy: A Retrospective Observational Study.
abstract: OBJECTIVE
  Despite recent advances in medical therapies for inflammatory bowel disease [IBD], little is known about their impact on inpatient management. Our objectives were to explore hospitalisation and surgery trends for all IBD patients in Italy at three time points over 7 years.
  
  
  METHODS
  National hospital discharge records were retrospectively reviewed for all admissions with a Crohn's disease [CD, 555*] or ulcerative colitis [UC, 556*] diagnosis in 2005, 2008, and 2011. Quantitative variables [mean, standard deviation] and categorical variables [frequencies] were described; comparison among admission-years was made by analysis of variance and chi-square tests. A multivariate logistic regression analysis was performed to identify predictors of surgery risk regarding demographics, inpatient management, and clinical features; p-values ≤ 0.05 were considered statistically significant.
  
  
  RESULTS
  Overall, 109657 hospitalisations occurred over the 3 years, with a decreasing trend observed in UC admissions. Mean age was higher in UC [50.1±19.7] than in CD [43.2±21.9]. The number of paediatric admissions rose from 3637 to 4372 between 2005 and 2011. An increasing proportion of CD [from 12.4% to 14.6%] and UC [from 5.8% to 8.0%] admissions reported a digestive system-related, surgical diagnosis-related group in the same period; overall, gastrointestinal surgical admissions increased from 3299 to 3964. In regression analysis, male gender, age, admission year, northern university hospital, disease localisation, and cancer as independent factors significantly affected the likelihood of surgery.
  
  
  CONCLUSIONS
  Despite a reduction in total IBD hospitalisations, surgical and paediatric admissions rose over time. Further study is needed to clarify benefits associated with new drugs in terms of inpatient management.
authors.affiliation: CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy michela.meregaglia@unibocconi.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Meregaglia
authors.affiliation: CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy.
authors.forename: Helen
authors.initials: H
authors.lastname: Banks
authors.affiliation: CeRGAS, Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fattore
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D003093:Colitis, Ulcerative / Q000628:therapy*; D003424:Crohn Disease / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D007155:Immunologic Factors
keywords: Crohn’s disease; hospitalisations; ulcerative colitis