Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

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

    Article  PubMed  Google Scholar 

  2. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel JF (2017) Ulcerative colitis. Lancet. 389(10080):1756–1770

    Article  PubMed  Google Scholar 

  3. 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

    Article  CAS  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  Google Scholar 

  5. 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

    Article  CAS  PubMed  Google Scholar 

  6. Aratari A, Papi C, Clemente V, Moretti A, Luchetti R, Koch M, Capurso L, Caprilli R (2008) Colectomy rate in acute severe ulcerative colitis in the infliximab era. Dig Liver Dis 40(10):821–826

    Article  CAS  PubMed  Google Scholar 

  7. Kaplan GG, Seow CH, Ghosh S, Molodecky N, Rezaie A, Moran GW, Proulx MC, Hubbard J, MacLean A, Buie D, Panaccione R (2012) Decreasing colectomy rates for ulcerative colitis: a population-based time trend study. Am J Gastroenterol 107(12):1879–1887

    Article  CAS  PubMed  Google Scholar 

  8. Reich KM, Chang HJ, Rezaie A, Wang H, Goodman KJ, Kaplan GG, Svenson LW, Lees G, Fedorak RN, Kroeker KI (2014) The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study. Aliment Pharmacol Ther 40(6):629–638

    Article  CAS  PubMed  Google Scholar 

  9. Moore Se MGKM, Peterson S et al (2014) Infliximab in ulcerative colitis: the impact of preoperative treatment on rates of colectomy and prescribing practices in the province of British Columbia, Canada. Dis Colon Rectum 57:83–90

    Article  PubMed  Google Scholar 

  10. Parragi L, Fournier N, Zeitz J, Scharl M, Greuter T, Schreiner P, Misselwitz B, Safroneeva E, Schoepfer AM, Vavricka SR, Rogler G, Biedermann L, Swiss IBD Cohort Study Group, Anderegg C, Bauerfeind P, Beglinger C, Begré S, Belli D, Bengoa JM, Biedermann L, Bigler B, Binek J, Blattmann M, Boehm S, Borovicka J, Braegger CP, Brunner N, Bühr P, Burnand B, Burri E, Buyse S, Cremer M, Criblez DH, de Saussure P, Degen L, Delarive J, Doerig C, Dora B, Dorta G, Egger M, Ehmann T, el-Wafa A, Engelmann M, Ezri J, Felley C, Fliegner M, Fournier N, Fraga M, Frei P, Frei R, Fried M, Froehlich F, Funk C, Ivano Furlano R, Gallot-Lavallée S, Geyer M, Girardin M, Golay D, Grandinetti T, Gysi B, Haack H, Haarer J, Helbling B, Hengstler P, Herzog D, Hess C, Heyland K, Hinterleitner T, Hiroz P, Hirschi C, Hruz P, Iwata R, Jost R, Juillerat P, Brondolo VK, Knellwolf C, Knoblauch C, Köhler H, Koller R, Krieger-Grübel C, Kullak-Ublick G, Künzler P, Landolt M, Lange R, Serge Lehmann F, Macpherson A, Maerten P, Maillard MH, Manser C, Manz M, Marbet U, Marx G, Matter C, McLin V, Meier R, Mendanova M, Meyenberger C, Michetti P, Misselwitz B, Moradpour D, Morell B, Mosler P, Mottet C, Müller C, Müller P, Müllhaupt B, Münger-Beyeler C, Musso L, Nagy A, Neagu M, Nichita C, Niess J, Noël N, Nydegger A, Obialo N, Oneta C, Oropesa C, Peter U, Peternac D, Petit LM, Piccoli-Gfeller F, Pilz JB, Pittet V, Raschle N, Rentsch R, Restellini S, Richterich JP, Rihs S, Ritz MA, Roduit J, Rogler D, Rogler G, Rossel JB, Sagmeister M, Saner G, Sauter B, Sawatzki M, Schäppi M, Scharl M, Schelling M, Schibli S, Schlauri H, Uebelhart SS, Schnegg JF, Schoepfer A, Seibold F, Seirafi M, Semadeni GM, Semela D, Senning A, Sidler M, Sokollik C, Spalinger J, Spangenberger H, Stadler P, Steuerwald M, Straumann A, Straumann-Funk B, Sulz M, Thorens J, Tiedemann S, Tutuian R, Vavricka S, Viani F, Vögtlin J, von Känel R, Vonlaufen A, Vouillamoz D, Vulliamy R, Wermuth J, Werner H, Wiesel P, Wiest R, Wylie T, Zeitz J, Zimmermann D (2018) Colectomy rates in ulcerative colitis are low and decreasing: 10 year follow-up data from the Swiss IBD cohort study. J Crohns Colitis 12(7):811–818

    Article  PubMed  Google Scholar 

  11. Kin C (2017) Bundorf M. as infliximab use for ulcerative colitis has increased, so has the rate of surgical resection. J Gastrointest Surg 21(7):1159–1165

    Article  PubMed  Google Scholar 

  12. Geltzeiler CB, Lu KC, Diggs BS, Deveney KE, Keyashian K, Herzig DO, Tsikitis VL (2014) Initial surgical management of ulcerative colitis in the biologic era. Dis Colon Rectum 57(12):1358–1363

    Article  PubMed  Google Scholar 

  13. Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (2018) Introduction to the HCUP National Inpatient Sample (NIS). HCUP Central Distributor

  14. Poojary P, Saha A, Chauhan K et al (2017) Predictors of hospital readmissions for ulcerative colitis in the United States: a National Database Study. Inflamm Bowel Dis 23(3):347–356

    PubMed  PubMed Central  Google Scholar 

  15. Baram D, Daroowalla F, Garcia R et al (2008) Use of the all patient refined-diagnosis related group (APR-DRG) risk of mortality score as a severity adjustor in the medical ICU. Clin Med Circ Respir Pulm Med 2:19–25

    Google Scholar 

  16. Sedman AB, Bahl V, Bunting E et al (2004) Clinical redesign using all patient refined diagnosis related groups. Pediatrics. 114(4):965–969

    Article  PubMed  Google Scholar 

  17. Kim H-J, Fay MP, Feuer EJ, Midthune DN (2000) Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 19(3):335–351

    Article  CAS  PubMed  Google Scholar 

  18. Yu H, Maclasaac D, Wong JJ et al (2018) Market share and costs of biologic therapies for inflammatory bowel disease in the USA. Aliment Pharmacol Ther 47(3):364–370

    Article  CAS  PubMed  Google Scholar 

  19. Gibson DJ, Heetun ZS, Redmond CE, Nanda KS, Keegan D, Byrne K, Mulcahy HE, Cullen G, Doherty GA (2015) An accelerated infliximab induction regimen reduces the need for early colectomy in patients with acute severe ulcerative colitis. Clin Gastroenterol Hepatol 13(2):330–335.e1

    Article  CAS  PubMed  Google Scholar 

  20. Nguyen GC, Torres EA, Regueiro M, Bromfield G, Bitton A, Stempak J, Dassopoulos T, Schumm P, Gregory FJ, Griffiths AM, Hanauer SB, Hanson J, Harris ML, Kane SV, Orkwis HK, Lahaie R, Oliva-Hemker M, Pare P, Wild GE, Rioux JD, Yang H, Duerr RH, Cho JH, Steinhart AH, Brant SR, Silverberg MS (2006) Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic whites: characterization of a large north American cohort. Am J Gastroenterol 101:1012–1023

    Article  Google Scholar 

  21. Flasar MH, Quezada S, Bijpuria P, Cross RK (2008) Racial differences in disease extent and severity in patients with ulcerative colitis: a retrospective cohort study. Dig Dis Sci 53:2754–2760

    Article  PubMed  Google Scholar 

  22. Sofia MA, Rubin DT, Hou N, Pekow J (2014) Clinical presentation and disease course of inflammatory bowel disease differs by race in a large tertiary care hospital. Dig Dis Sci 59:2228–2235

    Article  PubMed  PubMed Central  Google Scholar 

  23. Li D, Collins B, Velayos FS, Liu L, Lewis JD, Allison JE, Flowers NT, Hutfless S, Abramson O, Herrinton LJ (2014) Racial and ethnic differences in health care utilization and outcomes among ulcerative colitis patients in an integrated health-care organization. Dig Dis Sci 59:287–294

    Article  PubMed  Google Scholar 

  24. Nguyen G, Laveist T, Gearhart S et al (2006) Racial and geographic variations in colectomy rates among hospitalized ulcerative colitis patients. Clin Gastroenterol Hepatol 4:1507–1513

    Article  PubMed  Google Scholar 

  25. Nguyen GC, Bayless TM, Powe NR, LaVeist TA, Brant SR (2007) Race and health insurance are predictors of hospitalized Crohn’s disease patients undergoing bowel resection. Inflamm Bowel Dis 13:1408–1416

    Article  PubMed  Google Scholar 

  26. Collins KS, Hall A, Neuhaus CU (1999) S. Minority health: a chartbook. Commonwealth Fund, New York

    Google Scholar 

  27. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O II (2003) Defining culture competence: a practical framework for addressing racial/ethnic disparitis in health and health care. Public Health Rep 118(4):293–302

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ayanian JZ, Cleary PD, Weissman JS, Epstein AM (1999) The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med 341(22):1661–1669

    Article  CAS  PubMed  Google Scholar 

  29. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, Benchimol EI, Panaccione R, Ghosh S, Barkema HW, Kaplan GG (2012) Increasing incidence and prevalence of inflammatory bowel diseases with time, based on a systematic review. Gastroenterology. 142:46–54

    Article  PubMed  Google Scholar 

  30. Afzali A, Cross RK (2016) Racial and ethnic minorities with inflammatory bowel disease in the United States: a systematic review of disease characteristics and differences. Inflamm Bowel Dis 22(8):2023–2040

    Article  PubMed  Google Scholar 

Download references

Funding

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.

Author information

Author notes

  1. Maia Kayal and Aparna Saha contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Maia Kayal, Sudarshan Paramsothy, Robert Hirten, Louis Cohen, Zane Gallinger, Saurabh Mehandru, Judy Cho, Marla C. Dubinsky, Jean-Frederic Colombel, Benjamin Cohen & Ryan Ungaro

  2. Department of Medicine, Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Aparna Saha, Priti Poojary & Girish Nadkarni

  3. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Alexander Greenstein

Authors
  1. Maia Kayal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aparna Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Priti Poojary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sudarshan Paramsothy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Hirten
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Louis Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zane Gallinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Saurabh Mehandru
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Judy Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Alexander Greenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Girish Nadkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marla C. Dubinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jean-Frederic Colombel
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Benjamin Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ryan Ungaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Maia Kayal.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kayal, M., Saha, A., Poojary, P. et al. Emergent colectomy rates decreased while elective ileal pouch rates were stable over time: a nationwide inpatient sample study. Int J Colorectal Dis 34, 1771–1779 (2019). https://doi.org/10.1007/s00384-019-03375-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03375-2

Keywords

Search

Navigation