title: Is Modern Medical Management Changing Ultimate Patient Outcomes in Inflammatory Bowel Disease?
abstract: The impact of modern medical management of inflammatory bowel disease (IBD) on surgical necessity and outcomes remains unclear. We hypothesized that surgery rates have decreased while outcomes have worsened due to operating on "sicker" patients since the introduction of biologic medications.
  
  
  
  The Nationwide Inpatient Sample and ICD-9-CM codes were used to identify inpatient admissions for Crohn's disease and ulcerative colitis. Trends in IBD nutrition, surgeries, and postoperative complications were determined.
  
  
  
  There were 191,743 admissions for IBD during the study period. Surgery rates were largely unchanged over the study period, ranging from 9 to 12 % of admissions in both Crohn's disease and ulcerative colitis. The rate of poor nutrition increased by 67 % in ulcerative colitis and by 83 % in Crohn's disease. Rates of postoperative anastomotic leak (10.2-13.9 %) were unchanged over the years. Postoperative infection rates decreased by 17 % in Crohn's disease (18 % in 2003 to 15 % in 2012; P < 0.001) but did not show a trend in any direction in ulcerative colitis.
  
  
  
  Rates of IBD surgery have remained stable while postoperative infectious complications have remained stable or decreased since the implementation of biologic therapies. We identified an increase in poor nutrition in surgical patients.
authors.affiliation: Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA, 98431, USA. qhatch@gmail.com.
authors.forename: Quinton M
authors.initials: QM
authors.lastname: Hatch
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Rubina
authors.initials: R
authors.lastname: Ratnaparkhi
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Althans
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Keating
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Ruel
authors.initials: R
authors.lastname: Neupane
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Madhuri
authors.initials: M
authors.lastname: Nishtala
authors.affiliation: Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA, 98431, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000453:epidemiology* / Q000601:surgery* / Q000628:therapy; D003424:Crohn Disease / Q000453:epidemiology* / Q000601:surgery* / Q000628:therapy; D006801:Humans; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Crohn’s disease; Inflammatory bowel disease; Surgery; Ulcerative colitis