Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct;34(10):1771-1779.
doi: 10.1007/s00384-019-03375-2. Epub 2019 Sep 11.

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

Maia Kayal  1 , Aparna Saha  2 , Priti Poojary  2 , Sudarshan Paramsothy  3 , Robert Hirten  3 , Louis Cohen  3 , Zane Gallinger  3 , Saurabh Mehandru  3 , Judy Cho  3 , Alexander Greenstein  4 , Girish Nadkarni  2 , Marla C Dubinsky  3 , Jean-Frederic Colombel  3 , Benjamin Cohen  3 , Ryan Ungaro  3
Affiliations

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

Maia Kayal et al. Int J Colorectal Dis. 2019 Oct.

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.

Keywords: Colectomy; Disparities; Ileal pouch anal anastomosis; Minority; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Emergent colectomy and elective IPAA rates during UC admissions. 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). UC ulcerative colitis, APC annual percent change
Fig. 2
Fig. 2
a Differences in emergent colectomy rates based on age, insurance status, and race. Rates of emergent colectomy declined similarly over time across demographics, though not as marked among patients aged 50 and older and among Medicare patients. There were no significant differences in emergent colectomy rates by race. n.s. not significant. b Differences in elective IPAA rates based on age, insurance status, and race. Ileal pouch anal anastomosis (IPAA) rates were consistently and significantly lower among patients age 65 and older. IPAA were similarly stable over time across demographics but were consistently higher among whites and private insurance patients
Fig. 2
Fig. 2
a Differences in emergent colectomy rates based on age, insurance status, and race. Rates of emergent colectomy declined similarly over time across demographics, though not as marked among patients aged 50 and older and among Medicare patients. There were no significant differences in emergent colectomy rates by race. n.s. not significant. b Differences in elective IPAA rates based on age, insurance status, and race. Ileal pouch anal anastomosis (IPAA) rates were consistently and significantly lower among patients age 65 and older. IPAA were similarly stable over time across demographics but were consistently higher among whites and private insurance patients
See this image and copyright information in PMC

References

    1. Fumery M, Singh S, Dulai PS et al. (2018) Natural history of adult ulcerative colitis in population-based cohorts: a systematic review. Clin Gastroenterol Hepatol 16(3):343–356 - PMC - PubMed
    1. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF (2017) Ulcerative colitis. Lancet. 389(10080):1756–1770 - PMC - PubMed
    1. Jarnerot G, Hertervig E, Friis-liby I et al. (2005) Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo controlled study. Gastroenterology. 128:1805–1811 - PubMed
    1. Gustavsson A, Jarnerot G, Hertervig E et al. (2010) Clinical trial: colectomy after rescue therapy in ulcerative colitis - 3-year follow-up of the Swedish-Danish controlled infliximab study. Aliment Pharmacol Ther 32:984–989 - PubMed
    1. Sandborn WJ, Rutgeerts P, Feagan BG, Reinisch W, Olson A, Johanns J, Lu J, Horgan K, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJS, Present D, Sands BE, Colombel JF (2009) Colectomy rate comparison after treatment of ulcerative colitis with placebo or infliximab. Gastroenterology. 137: 1250–1260 quiz 1520 - PubMed

LinkOut - more resources