Emergent colectomy rates decreased while elective ileal pouch rates were stable over time: a nationwide inpatient sample study
| Autor: | Alexander Greenstein, Marla Dubinsky, Zane Gallinger, Robert Hirten, Ryan C. Ungaro, Sudarshan Paramsothy, Maia Kayal, Jean-Frederic Colombel, Priti Poojary, Louis J. Cohen, Aparna Saha, Saurabh Mehandru, Judy H. Cho, Benjamin L. Cohen, Girish N. Nadkarni |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Demographics medicine.medical_treatment Colonic Pouches Article 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Colectomy Inpatients Subtotal Colectomy business.industry General surgery Racial Groups Gastroenterology Age Factors Hepatology Middle Aged medicine.disease Ulcerative colitis Ileal Pouch Anal Anastomosis Hospitalization 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Colitis Ulcerative Female Diagnosis code Pouch business |
| Zdroj: | International journal of colorectal disease. 34(10) |
| ISSN: | 1432-1262 |
| Popis: | PURPOSE: Despite advances in biologic therapy, approximately 10–15% of ulcerative colitis (UC) patients require surgery. We aimed to (1) examine the rates of emergent colectomy and elective ileal pouch anal anastomosis (IPAA) over time among UC patients in the USA and (2) investigate disparities in surgery rates by patient demographics. METHODS: Data from the Nationwide Inpatient Sample (NIS) from 2000 to 2014were analyzed. Inclusion criteria were admissions with a primary UC ICD-9-CM diagnosis code and age > 18. Emergent cases were defined as those admitted through the emergency room with an outcome ICD-9-CM code for subtotal colectomy. Elective IPAA cases were defined with an outcome ICD-9-CM code for IPAA, used as a surrogate measure of colectomy. Patient and hospital-level demographics were analyzed. Temporal trends of colectomy were analyzed utilizing joinpoint-regression analysis with calculation of annual percentage change (APC). RESULTS: A total of 470,708 admissions were included over the 14-year period. Emergent colectomy rate significantly declined (APC − 7.35%, p = 0.0002), while the rate of elective IPAA remained stable (APC − 0.21%, p = 0.8). Emergent colectomy rates declined similarly across all demographics, though not as marked among patients age 50 and older and Medicare patients. Elective IPAA rates were significantly lower among blacks and patients with public insurance. CONCLUSIONS: There has been a significant decline in emergent UC colectomy rates in the USA; however, the overall need for surgery appears unchanged given stable IPAA rates. This suggests a limited impact on overall surgery rates with a shift from emergent to elective procedures. |
| Databáze: | OpenAIRE |
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