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Mo1255 Complications and Length of Stay After Cholecystectomy Are Increased Among Men With IBD
Complications and Length of Stay After Cholecystectomy Are Increased Among Men With IBD Hala Al-Jiboury, Adam V. Weizman, Dror Berel, Marc Berns, Marla Dubinsky, Stephan R. Targan, Eric A. Vasiliauskas, David Q. Shih, Manreet Kaur, Andrew Ippoliti, Dermot P. McGovern, Gil Y. Melmed
Mo1253 National Trends and Inpatient Outcomes of Inflammatory Bowel Disease With Concomitant Chronic Liver Disease Douglas L. Nguyen, M. Mazen Jamal
Introduction: Cholecystectomy is the most common abdominal surgery in the United States. Recent studies have suggested that patients with inflammatory bowel disease (IBD) are at higher risk of post-cholecystectomy complications (Navaneethan 2012). We aimed to characterize and identify risk factors for complications after cholecystectomy at a tertiary IBD center. Methods: Using discharge codes, 118 patients who underwent cholecystectomy at our institution (1/1/2000 to 10/31/2012) with concomitant IBD were identified for medical record review. Data collection included demographics, body mass index (BMI), comorbidities, prior surgeries, smoking history, IBD phenotype, and concurrent therapies. Primary endpoints included a) acuity of cholecystectomy (elective vs emergent) b) postoperative complications (infections, bile leak, ileus, small bowel obstruction, intensive care (ICU)) c) length of stay (LOS). Statistical analysis included univariate and multivariable methods. Results: We identified 58 subjects with confirmed IBD (Crohn's disease n=41, ulcerative colitis n= 17) and cholecystectomy (55% female, mean age 50 yrs (range 24 to 84), mean BMI 24.9 (range 16 to 41)). At the time of surgery, 50% were not on any immunosuppressant medication, 31% were on immunomodulators, 31% on steroids, and 21% on anti-TNFs. Those on any immunosuppressant had a longer LOS after surgery compared to those not on immunosuppressant therapy (4.7 days vs 3.6 days, p=0.04). Emergent cholecystectomy (compared to elective) was associated with a longer duration of IBD (483 mo. vs 176 mo, p=0.03), older age (p=0.003), male gender (p=0.03), and ever-smoking (p=0.02). Increasing age was also associated with transfer to the ICU (p=0.02) and postoperative ileus (p=0.04). Patients with Crohn's disease were more likely to have concurrent pancreatitis than those with UC (44% vs 18%, p=0.05). Only 7% women vs 28% men had histologic acute cholecystitis (p=0.06); the remainder had chronic changes only. Men were more likely to experience postoperative ileus (p=0.03) and ICU admission (p=0.006), and had a longer LOS (mean 6.1 days vs 2.6 days, p=0.02) than women. After adjusting for multiple covariates, male gender remained associated with longer LOS after cholecystectomy. Immunosuppressant use, and specifically anti-TNF therapy, was not associated with increased postoperative complications. Conclusion: Men with IBD are more likely than women to experience postoperative complications after cholecystectomy, leading to a longer LOS after surgery. Other factors associated with postoperative outcomes include older age, smoking, and longer duration of IBD. Further characterization of risk factors is warranted to clarify preventable causes of increased post-cholecystectomy complications in patients with IBD.
Background: There is little information on the frequency of chronic liver disease among hospitalized patients with Inflammatory Bowel Disease (IBD). In this study, we seek to define common etiologies contributing chronic liver disease among IBD patients and identifying potential risk factors predictive of increased mortality in this population. Methods: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. A multivariate analysis was performed to identify factors predictive of increased inpatient mortality. Results: From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has nearly tripled from 0.75 per 100,000 persons in 19882001 to 2.15 per 100, 000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among Ulcerative Colitis patients were: primary sclerosing cholangitis (50.62%), cryptogenic cirrhosis (20.17%), non-alcoholic fatty liver disease (12.73%), chronic hepatitis C (11.00%), primary biliary cirrhosis (4.15%), and chronic hepatitis B (1.33%). In contrast, the most common etiologies contributing to chronic liver disease in Crohn's patients were: primary sclerosing cholangitis (26.54%), chronic hepatitis C (23.99%), cryptogenic cirrhosis (23.99%), non-alcoholic fatty liver disease 20.26%), chronic hepatitis B (3.05%), and primary biliary cirrhosis (2.17%). Compared to IBD patients without concomitant liver disease, there was a 2.5-fold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.76% vs. 1.29%, p ,0.01). The multivariate analysis showed that factors predictive of inpatient mortality among IBD patients with liver disease include— age .50 (OR 1.83 95% CI 1.44, 2.34), spontaneous bacterial peritonitis (OR 2.93 95% CI 2.24, 3.83), hepatic encephalopathy (OR 3.77, 2.75, 5.16), presence of cirrhosis (1.93 OR 95% CI 1.51, 2.48), and Clostridium difficile colitis (OR 2.36 95% 1.29, 4.32). Geographic location, hospital size, and variceal hemorrhage were not predictive of increased mortality. Conclusions: The age-adjusted rate of chronic liver disease among hospitalized IBD patients has nearly tripled since 1988. There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease. Factors predictive of increased morality include older age, Clostridium difficile infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and the presence of cirrhosis. Therefore, early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity. Mo1254 Reduction in Colectomy- and Health Care-Related Costs in Ulcerative Colitis Patients Treated With Adalimumab Compared With Standard Therapy Michael V. Chiorean, Mei Yang, Joanne Rizzo, Parvez Mulani, Jingdong Chao Background: Anti-tumor necrosis factor agents are effective for treating patients with ulcerative colitis (UC). Aim: Our aim in this study was to determine the effect of treatment with adalimumab (ADA) vs. immunosuppressants or steroids (IMS) on health care utilization and cost of care in patients with UC. Methods: Adult patients (.18 years) were selected from the Truven Health MarketScan® Commercial Claims and Encounters databases if they had ≥1 inpatient or ≥2 outpatient claims corresponding to a diagnosis of UC ( International Statistical Classification of Diseases, 9th Revision [ICD-9], code/modifier 556.x) during a 5year interval (2005-2009). Patients with concurrent diagnosis of Crohn's disease (ICD-9 code, 555.x) and those receiving other biologics were excluded. Patients receiving ADA or IMS were grouped into 2 mutually exclusive cohorts: an ADA arm (with or without IMS) and an IMS-only arm. Patients had to be continuously enrolled during the 12-month period before (baseline) and after (follow-up) the biologic or IMS initiation date. Changes from baseline in UC-related hospitalizations (rate and length of stay [LOS]), outpatient services, corresponding health care costs, and colectomy (rate and LOS) were compared between the ADA and IMS arms. Results: Of the 9,230 patients with UC eligible for the study, 143 received ADA, and 9,087 received IMS only. There were no differences in age or sex between the 2 groups, although ADA-treated patients had more comorbidities and greater steroid usage at baseline compared with the IMS-treated patients (69.2% vs. 32.1%, P ,.05). From baseline to follow-up, ADA-treated patients had significant reductions in UC-related hospitalizations and LOS, whereas IMS-treated patients had increases in these outcomes (table). UC-related outpatient service utilization and costs, as well as total inpatient and outpatient service costs, decreased significantly for ADA-treated patients compared with a small increase for IMS-treated patients. ADA-treated patients also had a significantly greater reduction in hospital LOS for colectomy. Conclusion: In this retrospective claims database analysis, when compared with IMS therapy, ADA therapy was associated with greater reductions in UC-related hospitalization rates, length of hospitalization for colectomy, and total inpatient and outpatient medical service costs. Difference in Outcomes: 12-Month Post- vs. Pre-treatment Initiation
Graph: Post-cholecystectomy complications are increased among men with IBD relative to women Mo1256 Role of Fecal Calprotection in Predicting Ileocolonic Endoscopic Recurrence in Postoperative Crohn's Disease Christian Primas, Gertrud Frühwald, Sieglinde Angelberger, David Allerstorfer, Pavol Papay, Alexander Eser, Cornelia Gratzer, Clemens Dejaco, Walter Reinisch, Gottfried Novacek, Harald Vogelsang Introduction: Fecal calprotectin nicely correlates with intestinal disease activity in Crohn's disease. It was the aim of this study to evaluate its role in predicting endoscopic recurrence in postoperative Crohn's disease. Material and Methods: 62 patients who underwent ileocolonic resection due to Crohn's diease at the General Hospital of Vienna were prospectively followed up. Ileocolonoscopy was done 6 to 18 months postoperatively and scored after Rutgeerts. Endoscopic recurrence was defined as i2b (at least i2 in terminal ileum) or higher. Endoscopic pictures were reviewed by 2 independent reviewers unaware of the calprotectin results. 5 patients had to be excluded because the terminal ileum was not reached. 57 patients were evaluated. The median age was 41 (range 22 to 68), 32 male (56,1%), 25 female. Montreal Classification: A2 (35%), A3 (65%); L1 (10%), L2 (15%), L3 (67,5%), L4 (7,5); B1 (2,5%), B2 (40%), B3 (57,5%); none had perianal disease. Stool specimens were collected immediately
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AGA Abstracts
AGA Abstracts
Mo1255
Mo1253 National Trends and Inpatient Outcomes of Inflammatory Bowel Disease With Concomitant Chronic Liver Disease Douglas L. Nguyen, M. Mazen Jamal
Introduction: Cholecystectomy is the most common abdominal surgery in the United States. Recent studies have suggested that patients with inflammatory bowel disease (IBD) are at higher risk of post-cholecystectomy complications (Navaneethan 2012). We aimed to characterize and identify risk factors for complications after cholecystectomy at a tertiary IBD center. Methods: Using discharge codes, 118 patients who underwent cholecystectomy at our institution (1/1/2000 to 10/31/2012) with concomitant IBD were identified for medical record review. Data collection included demographics, body mass index (BMI), comorbidities, prior surgeries, smoking history, IBD phenotype, and concurrent therapies. Primary endpoints included a) acuity of cholecystectomy (elective vs emergent) b) postoperative complications (infections, bile leak, ileus, small bowel obstruction, intensive care (ICU)) c) length of stay (LOS). Statistical analysis included univariate and multivariable methods. Results: We identified 58 subjects with confirmed IBD (Crohn's disease n=41, ulcerative colitis n= 17) and cholecystectomy (55% female, mean age 50 yrs (range 24 to 84), mean BMI 24.9 (range 16 to 41)). At the time of surgery, 50% were not on any immunosuppressant medication, 31% were on immunomodulators, 31% on steroids, and 21% on anti-TNFs. Those on any immunosuppressant had a longer LOS after surgery compared to those not on immunosuppressant therapy (4.7 days vs 3.6 days, p=0.04). Emergent cholecystectomy (compared to elective) was associated with a longer duration of IBD (483 mo. vs 176 mo, p=0.03), older age (p=0.003), male gender (p=0.03), and ever-smoking (p=0.02). Increasing age was also associated with transfer to the ICU (p=0.02) and postoperative ileus (p=0.04). Patients with Crohn's disease were more likely to have concurrent pancreatitis than those with UC (44% vs 18%, p=0.05). Only 7% women vs 28% men had histologic acute cholecystitis (p=0.06); the remainder had chronic changes only. Men were more likely to experience postoperative ileus (p=0.03) and ICU admission (p=0.006), and had a longer LOS (mean 6.1 days vs 2.6 days, p=0.02) than women. After adjusting for multiple covariates, male gender remained associated with longer LOS after cholecystectomy. Immunosuppressant use, and specifically anti-TNF therapy, was not associated with increased postoperative complications. Conclusion: Men with IBD are more likely than women to experience postoperative complications after cholecystectomy, leading to a longer LOS after surgery. Other factors associated with postoperative outcomes include older age, smoking, and longer duration of IBD. Further characterization of risk factors is warranted to clarify preventable causes of increased post-cholecystectomy complications in patients with IBD.
Background: There is little information on the frequency of chronic liver disease among hospitalized patients with Inflammatory Bowel Disease (IBD). In this study, we seek to define common etiologies contributing chronic liver disease among IBD patients and identifying potential risk factors predictive of increased mortality in this population. Methods: We analyzed the Nationwide Inpatient Sample from 1988-2006 to determine the frequency of chronic liver disease among patients with IBD and to determine their in-hospital outcomes. A multivariate analysis was performed to identify factors predictive of increased inpatient mortality. Results: From 1988 to 2006, the age-adjusted rate of chronic liver disease among hospitalized patients with IBD has nearly tripled from 0.75 per 100,000 persons in 19882001 to 2.15 per 100, 000 persons in 2004-2006. The most common etiologies contributing to chronic liver disease among Ulcerative Colitis patients were: primary sclerosing cholangitis (50.62%), cryptogenic cirrhosis (20.17%), non-alcoholic fatty liver disease (12.73%), chronic hepatitis C (11.00%), primary biliary cirrhosis (4.15%), and chronic hepatitis B (1.33%). In contrast, the most common etiologies contributing to chronic liver disease in Crohn's patients were: primary sclerosing cholangitis (26.54%), chronic hepatitis C (23.99%), cryptogenic cirrhosis (23.99%), non-alcoholic fatty liver disease 20.26%), chronic hepatitis B (3.05%), and primary biliary cirrhosis (2.17%). Compared to IBD patients without concomitant liver disease, there was a 2.5-fold higher rate of inpatient morality among IBD patients with concomitant liver disease (2.76% vs. 1.29%, p ,0.01). The multivariate analysis showed that factors predictive of inpatient mortality among IBD patients with liver disease include— age .50 (OR 1.83 95% CI 1.44, 2.34), spontaneous bacterial peritonitis (OR 2.93 95% CI 2.24, 3.83), hepatic encephalopathy (OR 3.77, 2.75, 5.16), presence of cirrhosis (1.93 OR 95% CI 1.51, 2.48), and Clostridium difficile colitis (OR 2.36 95% 1.29, 4.32). Geographic location, hospital size, and variceal hemorrhage were not predictive of increased mortality. Conclusions: The age-adjusted rate of chronic liver disease among hospitalized IBD patients has nearly tripled since 1988. There is a higher rate of inpatient mortality among patients with concomitant IBD and chronic liver disease. Factors predictive of increased morality include older age, Clostridium difficile infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and the presence of cirrhosis. Therefore, early recognition and management of complications related to portal hypertension among patients with IBD and chronic liver disease is particularly important in order to reduce inpatient mortality and morbidity. Mo1254 Reduction in Colectomy- and Health Care-Related Costs in Ulcerative Colitis Patients Treated With Adalimumab Compared With Standard Therapy Michael V. Chiorean, Mei Yang, Joanne Rizzo, Parvez Mulani, Jingdong Chao Background: Anti-tumor necrosis factor agents are effective for treating patients with ulcerative colitis (UC). Aim: Our aim in this study was to determine the effect of treatment with adalimumab (ADA) vs. immunosuppressants or steroids (IMS) on health care utilization and cost of care in patients with UC. Methods: Adult patients (.18 years) were selected from the Truven Health MarketScan® Commercial Claims and Encounters databases if they had ≥1 inpatient or ≥2 outpatient claims corresponding to a diagnosis of UC ( International Statistical Classification of Diseases, 9th Revision [ICD-9], code/modifier 556.x) during a 5year interval (2005-2009). Patients with concurrent diagnosis of Crohn's disease (ICD-9 code, 555.x) and those receiving other biologics were excluded. Patients receiving ADA or IMS were grouped into 2 mutually exclusive cohorts: an ADA arm (with or without IMS) and an IMS-only arm. Patients had to be continuously enrolled during the 12-month period before (baseline) and after (follow-up) the biologic or IMS initiation date. Changes from baseline in UC-related hospitalizations (rate and length of stay [LOS]), outpatient services, corresponding health care costs, and colectomy (rate and LOS) were compared between the ADA and IMS arms. Results: Of the 9,230 patients with UC eligible for the study, 143 received ADA, and 9,087 received IMS only. There were no differences in age or sex between the 2 groups, although ADA-treated patients had more comorbidities and greater steroid usage at baseline compared with the IMS-treated patients (69.2% vs. 32.1%, P ,.05). From baseline to follow-up, ADA-treated patients had significant reductions in UC-related hospitalizations and LOS, whereas IMS-treated patients had increases in these outcomes (table). UC-related outpatient service utilization and costs, as well as total inpatient and outpatient service costs, decreased significantly for ADA-treated patients compared with a small increase for IMS-treated patients. ADA-treated patients also had a significantly greater reduction in hospital LOS for colectomy. Conclusion: In this retrospective claims database analysis, when compared with IMS therapy, ADA therapy was associated with greater reductions in UC-related hospitalization rates, length of hospitalization for colectomy, and total inpatient and outpatient medical service costs. Difference in Outcomes: 12-Month Post- vs. Pre-treatment Initiation
Graph: Post-cholecystectomy complications are increased among men with IBD relative to women Mo1256 Role of Fecal Calprotection in Predicting Ileocolonic Endoscopic Recurrence in Postoperative Crohn's Disease Christian Primas, Gertrud Frühwald, Sieglinde Angelberger, David Allerstorfer, Pavol Papay, Alexander Eser, Cornelia Gratzer, Clemens Dejaco, Walter Reinisch, Gottfried Novacek, Harald Vogelsang Introduction: Fecal calprotectin nicely correlates with intestinal disease activity in Crohn's disease. It was the aim of this study to evaluate its role in predicting endoscopic recurrence in postoperative Crohn's disease. Material and Methods: 62 patients who underwent ileocolonic resection due to Crohn's diease at the General Hospital of Vienna were prospectively followed up. Ileocolonoscopy was done 6 to 18 months postoperatively and scored after Rutgeerts. Endoscopic recurrence was defined as i2b (at least i2 in terminal ileum) or higher. Endoscopic pictures were reviewed by 2 independent reviewers unaware of the calprotectin results. 5 patients had to be excluded because the terminal ileum was not reached. 57 patients were evaluated. The median age was 41 (range 22 to 68), 32 male (56,1%), 25 female. Montreal Classification: A2 (35%), A3 (65%); L1 (10%), L2 (15%), L3 (67,5%), L4 (7,5); B1 (2,5%), B2 (40%), B3 (57,5%); none had perianal disease. Stool specimens were collected immediately
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AGA Abstracts
AGA Abstracts
Mo1255