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Is Modern Medical Management Changing Ultimate Patient Outcomes in Inflammatory Bowel Disease?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The impact of modern medical management of inflammatory bowel disease (IBD) on surgical necessity and outcomes remains unclear. We hypothesized that surgery rates have decreased while outcomes have worsened due to operating on “sicker” patients since the introduction of biologic medications.

Methods

The Nationwide Inpatient Sample and ICD-9-CM codes were used to identify inpatient admissions for Crohn’s disease and ulcerative colitis. Trends in IBD nutrition, surgeries, and postoperative complications were determined.

Results

There were 191,743 admissions for IBD during the study period. Surgery rates were largely unchanged over the study period, ranging from 9 to 12 % of admissions in both Crohn’s disease and ulcerative colitis. The rate of poor nutrition increased by 67 % in ulcerative colitis and by 83 % in Crohn’s disease. Rates of postoperative anastomotic leak (10.2–13.9 %) were unchanged over the years. Postoperative infection rates decreased by 17 % in Crohn’s disease (18 % in 2003 to 15 % in 2012; P < 0.001) but did not show a trend in any direction in ulcerative colitis.

Conclusions

Rates of IBD surgery have remained stable while postoperative infectious complications have remained stable or decreased since the implementation of biologic therapies. We identified an increase in poor nutrition in surgical patients.

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Author’s Contributions

Quinton Hatch: Primary investigator/author. Study conception and design, data collection and analysis, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Rubina Ratnaparkhi: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Alison Althans: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Michael Keating: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Ruel Neupane: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Madhuri Nishtala: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Eric Johnson: Associate investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

Scott R. Steele: Senior investigator/author. Study conception, interpretation of data, drafting the article and revising it critically for important intellectual content, final approval of version to be published.

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Authors and Affiliations

  1. Madigan Army Medical Center, 9040-A Fitzsimmons Drive, Tacoma, WA, 98431, USA

    Quinton M. Hatch & Eric K. Johnson

  2. University Hospitals Case Medical Center, Cleveland, OH, USA

    Rubina Ratnaparkhi, Alison Althans, Michael Keating, Ruel Neupane, Madhuri Nishtala & Scott R. Steele

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  1. Quinton M. Hatch
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  2. Rubina Ratnaparkhi
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Corresponding author

Correspondence to Quinton M. Hatch.

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The results and opinions expressed in this article are those of the authors and do not reflect the opinions or official policy of the US Army or the Department of Defense.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Hatch, Q.M., Ratnaparkhi, R., Althans, A. et al. Is Modern Medical Management Changing Ultimate Patient Outcomes in Inflammatory Bowel Disease?. J Gastrointest Surg 20, 1867–1873 (2016). https://doi.org/10.1007/s11605-016-3275-z

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  • DOI: https://doi.org/10.1007/s11605-016-3275-z

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