A. L. Stokes1, C. Hollenbeak1, T. Falaiye1 1Penn State Hershey Medical Center,Hershey, PA, USA
Introduction: Pediatric inflammatory bowel disease is globally increasing in incidence. Advances in medical and surgical therapy have improved outcomes over the past two decades. While inpatient hospitalizations and rates of surgery are reportedly decreasing in other countries, trends in the rates of various types of inpatient surgeries in the United States have not been widely reported.
Methods: Pediatric patients ≤20 years of age with either Crohn’s disease (CD) or ulcerative colitis (UC) were identified in the HCUP KID database (2003, 2006, 2009, 2012). Surgeries including bowel resection, stoma creation, and perianal or percutaneous drainage procedures were identified using ICD-9 procedure codes. Logistic regression was used to identify factors associated with surgical intervention, while linear regression was used to identify factors associated with LOS and costs. Regression was also used to test the significance of trends in procedure rates over time. Survey weights were used to obtain estimates of national trends.
Results: Increasing numbers of hospitalizations for both CD and UC patients from ages 0 to 20 were found from 2003-2012 (up from 126 per 100,000 hospitalizations to 197 for CD; up from 68 per 100,000 to 115 for UC, both p<0.001). UC patients had higher LOS (6.4 vs. 5.4 days, p<0.001) and hospitalization costs ($15,011.20 vs. $12,356.80, p<0.001). CD had higher rates of intestinal resection (10.0% vs. 8.1%, p<0.001), but rates of stoma creation were higher in UC (8.6% vs. 2.2%, p<0.001). Factors associated with both intestinal resection and stoma creation (ileostomy or colostomy) include age between 10-20 years, male gender, Caucasian or Asian race, elective admission, and admission to an urban teaching hospital (all p<0.05). Whereas resection was associated with CD and fewer comorbidities, stoma creation was associated with UC and greater number of comorbidities (all p<0.01). Perianal drainage and percutaneous drainage procedures were both significantly associated with CD diagnosis. Rates of these procedures did not change significantly over time, except for increased stoma creation in CD (OR 1.06, 95% confidence interval [CI] 1.03-1.09) and increased percutaneous drainage in UC (OR 1.07, CI 1.00-1.14).
Conclusion: Despite increasing hospitalizations, the rates of common procedures in pediatric IBD patients have remained stable in the US over the last decade, with the exception of increasing stoma creation in Crohn’s patients. This plateau may indicate improved medical control of IBD obviating the need for surgery, or changing indications for surgical treatment. Further studies examining changes in the timing of surgery and the effects of biologic agents on surgical rates are warranted.
