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International Journal of Colorectal Disease

, Volume 34, Issue 10, pp 1771–1779 | Cite as

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

  • Maia KayalEmail author
  • Aparna Saha
  • Priti Poojary
  • Sudarshan Paramsothy
  • Robert Hirten
  • Louis Cohen
  • Zane Gallinger
  • Saurabh Mehandru
  • Judy Cho
  • Alexander Greenstein
  • Girish Nadkarni
  • Marla C. Dubinsky
  • Jean-Frederic Colombel
  • Benjamin Cohen
  • Ryan Ungaro
Original Article

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

Ulcerative colitis Colectomy Ileal pouch anal anastomosis Minority Disparities 

Notes

Authorship

Guarantor of the article: Ryan Ungaro is the submission’s guarantor and takes responsibility for the integrity of the work as a whole, from inception to published article.

Author contributions: MK: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis; AS: study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, statistical analysis; PP: study concept and design, acquisition of data, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, statistical analysis; SP: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; RH: data analysis and interpretation of data, critical revision of the manuscript for important intellectual contents; LC: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; ZG: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; SM: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; JC: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; AG: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; GN: data analysis and interpretation of data, critical revision of the manuscript for important intellectual content; MCB: data analysis and interpretation of data, critical revision of intellectual content; JFC: study concept and design, data analysis and interpretation of data, critical revision of the manuscript for important intellectual contents; BC: study concept and design, data analysis and interpretation of data, critical revision of the manuscript for important intellectual contents; RU: study concept and design, data analysis and interpretation of data, critical revision of the manuscript for important intellectual contents. All authors provided final approval of the manuscript. All authors agree to be accountable for all aspects of work to ensure that questions regarding accuracy and integrity investigated and resolved.

Funding information

RCU is supported by a Career Development Award from the Crohn’s and Colitis Foundation and an NIH K23 Career Development Award (K23KD111995-01A1). RH is supported by a Crohn’s and Colitis Foundation Career Development Award. This research did not receive grants from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maia Kayal
    • 1
    Email author
  • Aparna Saha
    • 2
  • Priti Poojary
    • 2
  • Sudarshan Paramsothy
    • 1
  • Robert Hirten
    • 1
  • Louis Cohen
    • 1
  • Zane Gallinger
    • 1
  • Saurabh Mehandru
    • 1
  • Judy Cho
    • 1
  • Alexander Greenstein
    • 3
  • Girish Nadkarni
    • 2
  • Marla C. Dubinsky
    • 1
  • Jean-Frederic Colombel
    • 1
  • Benjamin Cohen
    • 1
  • Ryan Ungaro
    • 1
  1. 1.Department of Medicine, Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Department of Medicine, Division of NephrologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of SurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

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