title: Early Sigmoidoscopy or Colonoscopy Is Associated With Improved Hospital Outcomes in Ulcerative Colitis-Related Hospitalization.
abstract: OBJECTIVE
  Performing a sigmoidoscopy or colonoscopy is recommended for assessment of disease activity, excluding infection, and guiding medical treatment during ulcerative colitis (UC)-related hospitalizations. However, it is unknown whether the timing of endoscopy impacts clinical outcomes. The objective of our study was to determine the impact of timing of endoscopy on hospital outcomes in patients with UC-related hospitalizations.
  
  
  METHODS
  This is a cross-sectional study using data from the Nationwide Inpatient Sample database (2006-2013). Adult inpatients (≥19 years) with UC-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification codes (ICD-9-CM). Hospital outcomes stratified by disease severity were compared between patients receiving early (<3 days after admission) and delayed endoscopies (between 3 and 7 days after admission). The primary clinical outcomes included mortality, frequency of large intestine surgery, length of stay (LOS), and hospital cost. Results were analyzed using univariate and multivariate analyses.
  
  
  RESULTS
  Of a total of 84,359 patients with UC-related hospitalizations, 67.2% (56,657) underwent an early endoscopy and 32.8% (27,702) underwent a delayed endoscopy. Delayed endoscopy was associated with higher mortality (adjusted odds ratio: 1.76 (95% confidence interval (CI): 1.08, 2.88)), prolonged LOS (adjusted coefficient: 2.69 (95% CI: 2.61, 2.77)), and higher hospital cost (adjusted coefficient: $3,394 (95% CI: 3,234, 3,554)). In UC patients with intermediate disease severity, delayed endoscopy was associated with an increased frequency of large intestine surgery (adjusted odds ratio: 1.60 (95% CI: 1.01, 2.53)).
  
  
  CONCLUSIONS
  In UC-related hospitalizations, the timing of endoscopic procedures impacts outcomes. Early endoscopy is associated with decreased mortality and better health-care utilization (LOS and hospital cost) compared with delayed endoscopy. In UC patients with intermediate disease severity, early endoscopy is also associated with a decreased frequency of large intestine surgery.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Obi
authors.affiliation: Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Hinton
authors.affiliation: Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Sobotka
authors.affiliation: Department of Gastroenterology, Morristown Medical Center, Morristown, New Jersey, USA.
authors.forename: Razvan
authors.initials: R
authors.lastname: Arsenescu
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Somashekar G
authors.initials: SG
authors.lastname: Krishna
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Levine
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang