Incidence, features, in-hospital outcomes and predictors of in-hospital mortality associated with toxic megacolon hospitalizations in the United States
Toxic megacolon (TM) is a potentially fatal condition characterized by non-obstructive colonic dilatation and systemic toxicity. It is most commonly caused by inflammatory bowel disease (IBD). Limited data for TM are available demonstrating incidence, in-hospital outcomes and predictors of mortality. We sought to investigate incidence, characteristics, mortality and predictors of mortality associated with it. Data were obtained from the Healthcare Cost and Utilization Project (HCUP)’s Nationwide Inpatient Sample (NIS) database from January 2010 through December 2014. An analysis was performed on SAS 9.4 (SAS Institute Inc., Cary, NC). Patients below 18 years were excluded. A mixed-effects logistic regression model was developed to analyze predictors of mortality. Thus, 8139 (weighted) cases of TM were diagnosed between 2010 and 2014. TM is more prevalent in women (56.4%) than in men (43.6%), with a mean age of onset at 62.4 years, affecting whites (79.7%) more than non-whites. The most common reason for hospital admission included IBD (51.6%) followed by septicemia (10.2%) and intestinal infections (4.1%). Mean length of stay was 9.5 days and overall in-hospital mortality was 7.9%. Other complications included surgical resection of the large intestine (11.5%) and bowel obstruction (10.9%). Higher age, neurological disorder, coagulopathy, chronic pulmonary disease, heart failure, and renal failure were associated with greater risk of in-hospital mortality. TM is a serious condition with high in-hospital mortality. Management of TM requires an inter-disciplinary team approach with close monitoring. Patients with positive predictors in our study require special attention to prevent excessive in-hospital mortality.
KeywordsEpidemiology Inflammatory bowel disease In-hospital outcomes Predictors of mortality Toxic megacolon
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Statement of human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was not required as the data were obtained from NIS. It has deidentified hospitalization data.
Data availability statement
The data that support the findings of this study are openly available in Healthcare Cost and Utilization Project’s website at https://www.hcup-us.ahrq.gov/nisoverview.jsp. Reference Number: 19.
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