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Inflammatory Bowel Disease Adversely Impacts Colorectal Cancer Surgery Short-term Outcomes and Health-Care Resource Utilization.

ABSTRACT: Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC) compared to patients without IBD. There is a lack of population-based data evaluating the in-patient surgical outcomes of CRC in IBD patients. We sought to compare the hospital outcomes of CRC surgery between patients with and without IBD.We used the National Inpatient Sample (2008-2012) and Nationwide Readmissions Database (NRD, 2013) and selected all adult patients (age ?18 years) with ulcerative colitis (UC) or Crohn's disease (CD) who underwent CRC surgery. Multivariate analysis for in-patient outcomes of postoperative complications, health-care resource utilization, readmission rate, and mortality were performed.A total of 397,847 patients underwent CRC surgery from 2008 to 2012, of which 0.8% (3,242) had IBD. Compared to CRC in non-IBD patients, CRC in IBD patients had longer length of stay (adjusted coefficient (AC) 0.86 days, 95% confidence interval (CI): 0.42, 1.30), more likely developed postoperative complications (adjusted odds ratio (AOR) 1.26, 95% CI: 1.06, 1.50), including postoperative infection (AOR 1.69, 95% CI: 1.20, 2.38) and deep vein thrombosis (AOR 2.42, 95% CI: 1.36, 4.28), and more frequently required blood transfusion (AOR 1.59, 95% CI: 1.30, 1.94). CRC in IBD patients was more likely to be readmitted within 30 days (AOR 1.44, 95% CI: 1.01, 2.04).At a population level, IBD adversely impacts outcomes at the time of CRC surgery.

SUBMITTER: Ramsey M

PROVIDER: S-EPMC5717518 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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Inflammatory Bowel Disease Adversely Impacts Colorectal Cancer Surgery Short-term Outcomes and Health-Care Resource Utilization.

Ramsey Mitchell M Krishna Somashekar G SG Stanich Peter P PP Husain Syed S Levine Edward J EJ Conwell Darwin D Hinton Alice A Zhang Cheng C

Clinical and translational gastroenterology 20171130 11

<h4>Objectives</h4>Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC) compared to patients without IBD. There is a lack of population-based data evaluating the in-patient surgical outcomes of CRC in IBD patients. We sought to compare the hospital outcomes of CRC surgery between patients with and without IBD.<h4>Methods</h4>We used the National Inpatient Sample (2008-2012) and Nationwide Readmissions Database (NRD, 2013) and selected all adult patient ...[more]

PMID: 29189768

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Project description:Background:Chronic inflammatory diseases (CIDs; ankylosing spondylitis [AS], psoriatic arthritis [PsA], psoriasis [PsO], or rheumatoid arthritis [RA]) and inflammatory bowel disease (IBD; Crohn's disease and ulcerative colitis) are associated with substantial economic burden. The relative increased costs among patients with CIDs and concomitant IBD compared to those without IBD is an important consideration when deciding on the clinical management of patient symptoms. Given the increasing use of novel agents for the treatment of CIDs, including those that may increase the risk of IBD in patients with CIDs, the objective of the study was to describe the incidence of IBD and to quantify healthcare resource utilization (HRU) and costs associated with IBD among patients with CIDs. Methods:The IBM MarketScan® Research Databases (1/2010-7/2017) were used to identify adult patients with ?2 claims with a diagnosis of either AS/PsA/PsO/RA (index date was a random claim for AS/PsA/PsO/RA). The one-year incidence rate of IBD was calculated following the index date. HRU and healthcare costs were compared between patients developing and not developing IBD in the year following the index date, adjusting for baseline characteristics. Results:A total of 537,450 patients with CIDs (mean age?=?54.0?years; 63.1% female) were included in the study. The 1-year incidence rate of IBD was 0.52% (range?=?0.39% in patients with PsO but without PsA to 1.73% in patients with AS). Patients who developed IBD (N?=?2778) had significantly higher rates of inpatient, outpatient, and emergency room visits (incidence rate ratios [IRR]?=?2.91, 1.35, 1.81; all P?<?0.0001), compared to patients without IBD (N?=?534,672). Patients who developed IBD had $18,500 (P?<?0.0001) higher total costs per year, including $15,121 (P?<?0.0001) higher medical costs and $3380 higher pharmacy costs (P?<?0.0001). Conclusion:Higher HRU and costs were observed in patients with concomitant CID and IBD compared to patients with CID alone. Consideration should be given to treatment decisions that adequately manage CID and IBD to ensure optimal clinical and economic outcomes.

Dataset Information

Inflammatory Bowel Disease Adversely Impacts Colorectal Cancer Surgery Short-term Outcomes and Health-Care Resource Utilization.

Publications

Inflammatory Bowel Disease Adversely Impacts Colorectal Cancer Surgery Short-term Outcomes and Health-Care Resource Utilization.

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