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Published in: International Journal of Colorectal Disease 10/2019

01-10-2019 | Ulcerative Colitis | Original Article

Emergent colectomy rates decreased while elective ileal pouch rates were stable over time: a nationwide inpatient sample study

Authors: Maia Kayal, Aparna Saha, Priti Poojary, Sudarshan Paramsothy, Robert Hirten, Louis Cohen, Zane Gallinger, Saurabh Mehandru, Judy Cho, Alexander Greenstein, Girish Nadkarni, Marla C. Dubinsky, Jean-Frederic Colombel, Benjamin Cohen, Ryan Ungaro

Published in: International Journal of Colorectal Disease | Issue 10/2019

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Abstract

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 2014 were 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.
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Metadata
Title
Emergent colectomy rates decreased while elective ileal pouch rates were stable over time: a nationwide inpatient sample study
Authors
Maia Kayal
Aparna Saha
Priti Poojary
Sudarshan Paramsothy
Robert Hirten
Louis Cohen
Zane Gallinger
Saurabh Mehandru
Judy Cho
Alexander Greenstein
Girish Nadkarni
Marla C. Dubinsky
Jean-Frederic Colombel
Benjamin Cohen
Ryan Ungaro
Publication date
01-10-2019
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 10/2019
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-019-03375-2

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