Colectomy and Mortality Rates in Inflammatory Bowel Disease: A Nationwide Analysis

Purpose: To analyze nationwide adult (>=18 years) inpatient data from 2002-2007 to determine statistical significant factors in colectomy and mortality rates for patients presenting with fulminant inflammatory bowel disease. Methods: This is a cross-sectional retrospective study using hospital discharge data from the US Nationwide Inpatient Sample from 2002-2007. Patient admission characteristics were analyzed. There were a total of 161,903 and 95,201 discharged patients with Crohns Disease (CD) and Ulcerative Colitis (UC), respectively, as identified by ICD-9 code. The primary outcomes were inpatient colectomy (total or partial) and mortality rate. Risk factors specific to UC (C. difficile infection and proximity of colitis) were also analyzed. Results: Discharges of patients with CD and UC increased from 2002-2007 by 24.3% and 25.4%, respectively. Overall inpatient mortality of patients with CD and UC has remained relatively constant from 2002-2007 at 0.89% and 1.79%, respectively. Mortality rate for UC patients with inpatient colectomy was nearly four times greater than patients who did not have a colectomy. Procedure rates (either partial or total colectomy) associated with CD and UC decreased by 13.7% and 22.8%, respectively, from 2002-2007. Patients with concomitant C. difficile infection were more likely to have a colectomy. Patients with pancolitis UC were four times more likely to have colectomy compared to other types of UC (ileocolitis, proctitis), while patients with left sided UC were two times more likely to have colectomy compared to other types of UC. Conclusion: Colectomy rates for UC and CD have decreased with time, however inpatient mortality has remained relatively constant over the past decade. Patients with pancolitis were more likely to have a colectomy performed compared to patients with less extensive presentations of disease.