Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients

Abstract

Background: We sought to determine nationwide, population-based trends in rates of venous thromboembolism (VTE) among hospitalized inflammatory bowel disease (IBD) patients in the United States and to determine its mortality and economic impact.

Methods: We analyzed discharges from the Nationwide Inpatient Sample and used ICD-9-CM codes to identify Crohn's disease (CD) and ulcerative colitis (UC) between 1998 and 2004. Rates of VTE were compared between those with and without IBD. The impact of VTE on in-hospital mortality and resource utilization was quantified using regression analysis.

Results: After multivariate adjustment, both UC (OR 1.85, 95% CI 1.70-2.01) and CD discharges (OR 1.48, 95% CI 1.35-1.62) had higher rates of VTE compared to non-IBD discharges. Prevalence of VTE was greater among UC compared to CD discharges (OR 1.32, 95% CI 1.17-1.48). Among CD patients, active fistulizing disease was independently associated with greater VTE (OR 1.39, 95% CI 1.13-1.70). There was an annual 17% rise in odds of VTE among IBD admissions over 7 yr. VTE was associated with greater mortality among IBD patients (adjusted OR 2.50, 95% CI 1.83-3.43). This age- and comorbidity-adjusted excess mortality from VTE was 2.1-fold higher for IBD than for non-IBD patients (P < 0.0001). IBD patients with VTE had longer length of stay (11.7 vs 6.1 days, P < 0.0001) and incurred higher hospital charges ($47,515 vs $21,499; P < 0.0001).

Conclusions: VTE is increasingly prevalent among hospitalized IBD patients and has substantial mortality and economic impact. These findings drive the need for widespread prophylaxis against and early detection of VTE among IBD inpatients.