Utilization and surgical procedures following Colectomy in patients with Ulcerative Colitis

Colectomy is often viewed as a cure for ulcerative colitis (UC), yet complications from surgery may continue. This study was undertaken to compare utilization of hospital services and surgical procedures before and after colectomy in patients with ulcerative colitis (UC). A retrospective claims analysis was conducted for patients wit hUC aged 18 years and older using the MedStat Marketscan patient databases. Inclusion criteria included at least 2 claims for UC (556.xx), claim for colectomy with a diagnosis of UC, minimum of 24 months continuous enrollment, with ≥12 months post colectomy. Annual admissions/1,000, average length of stay (ALOS) and reimbursements associated with four surgical procedures (abscess drainage, ileostomy, stricturoplasty, surgical resection) were analyzed. Data from 330 patients were analyzed (average age: 48; 47% female). For the actual colectomy admission, ALOS was 9.7 days, and the average reimbursement per admission was $23,536. Utilization rates for UC-related emergency room (ER) visits (177.6 vs. 48.1; p<0.001) decreased significantly and hospitalizations (568.0 vs. 303.2; p= 0.09) trended downward following colectomy. However, the average reimbursement for hospitalizations increased significantly ($6,357 vs. $10,767, p<0.001) following colectomy. Prior to colectomy, there were 4 of the identified procedures, while there were 71 following colectomy (p<.001). Total surgical admissions for target procedures increased following colectomy (7.4 vs. 68.3, p<0.001), and for abscess drainage (0.00 vs. 27.0, p<0.001), ileostomy (3.7 vs. 36.6, p<0.001), and surgical resection (3.7 vs. 4.8, p= 0.32). There was no change in the average reimbursement per surgical admission post colectomy ($14,858 to $24,784; p= 0.63). In addition, the costs and ALOS associated with these procedures increased following colectomy for all procedures except for surgical resection, where the rate of procedures per 1,000 increased, but ALOS and cost per admission decreased. Our results revealed an increase in total surgical admissions, surgery rates, ALOS for surgical admissions, and average cost per admission following colectomy. Although hospitalizations for UC-related services decreased following colectomy, the costs for these hospitalizations increased. While colectomy is often viewed as a cure for UC, these analyses indicate that complications of the disease and its surgical treatment still occur following colectomy, and health plans continue to incur substantial costs.