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Racial Disparities in Readmissions for Patients with Inflammatory Bowel Disease (IBD) After Colorectal Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The incidence of inflammatory bowel disease (IBD) in minorities is increasing, and health outcome disparities are becoming more apparent. Our aim was to investigate the contribution of race to readmissions in IBD patients undergoing colorectal surgery.

Design

The National Surgical Quality Improvement Program database from 2012 to 2013 was queried for all patients with IBD undergoing elective colorectal surgery. After stratifying by race, unadjusted univariate and bivariate comparisons were made. Primary outcome was all-cause 30-day readmission. Predictors of readmission were identified using multivariable logistic regression.

Results

Of the 2523 patients with IBD who underwent elective colon surgery, 15.0 % were readmitted within 30 days of index operation. Black patients constituted 7.7 % of the entire cohort. Black patients were significantly different in smoking status (27 vs. 22 %) and Crohn’s diagnosis (84 vs. 73 %) (p < 0.05). Black patients had significantly higher readmission rates (20 vs. 15 %) and longer length-of-stays (8 vs. 6 days) after surgery (p < 0.05). On multivariable analysis, black race remained a significant predictor for 30-day readmissions in patients with IBD (odds ratio 1.6, 95 % confidence interval 1.1–2.5).

Conclusions

Black patients with IBD have an increased risk for readmission after colorectal surgery. Efforts to reduce readmissions need to target not only well-studied risk factors such as postoperative complications, but also investigate non-NSQIP-measured elements such as social and behavioral determinants of health.

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References

  1. Kappelman, M.D., et al., The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol, 2007. 5(12): p. 1424–9.

    Article  PubMed  Google Scholar 

  2. Loftus, E.V., Jr., Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology, 2004. 126(6): p. 1504–17.

    Article  PubMed  Google Scholar 

  3. Kappelman, M.D., et al., Direct health care costs of Crohn's disease and ulcerative colitis in US children and adults. Gastroenterology, 2008. 135(6): p. 1907–13.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Longobardi, T., P. Jacobs, and C.N. Bernstein, Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey. Am J Gastroenterol, 2003. 98(5): p. 1064–72.

    PubMed  Google Scholar 

  5. Sewell, J.L., H.F. Yee, Jr., and J.M. Inadomi, Hospitalizations are increasing among minority patients with Crohn's disease and ulcerative colitis. Inflamm Bowel Dis, 2010. 16(2): p. 204–7.

    Article  PubMed  Google Scholar 

  6. Cosnes, J., et al., Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology, 2011. 140(6): p. 1785–94.

    Article  PubMed  Google Scholar 

  7. Langholz, E., et al., Course of ulcerative colitis: analysis of changes in disease activity over years. Gastroenterology, 1994. 107(1): p. 3–11.

    CAS  PubMed  Google Scholar 

  8. Damle, R.N., et al., Clinical and financial impact of hospital readmissions after colorectal resection: predictors, outcomes, and costs. Dis Colon Rectum, 2014. 57(12): p. 1421–9.

    Article  PubMed  Google Scholar 

  9. Bernstein, C.N. and A. Nabalamba, Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study. Am J Gastroenterol, 2006. 101(1): p. 110–8.

    Article  PubMed  Google Scholar 

  10. Kelly, M., et al., Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res, 2012. 12: p. 77.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kassin, M.T., et al., Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg, 2012. 215(3): p. 322–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Girotti, M.E., et al., Racial disparities in readmissions and site of care for major surgery. J Am Coll Surg, 2014. 218(3): p. 423–30.

    Article  PubMed  Google Scholar 

  13. Frolkis, A., et al., Postoperative complications and emergent readmission in children and adults with inflammatory bowel disease who undergo intestinal resection: a population-based study. Inflamm Bowel Dis, 2014. 20(8): p. 1316–23.

    Article  PubMed  Google Scholar 

  14. Nguyen, G.C., N. Bollegala, and C.A. Chong, Factors associated with readmissions and outcomes of patients hospitalized for inflammatory bowel disease. Clin Gastroenterol Hepatol, 2014. 12(11): p. 1897–1904 e1.

    Article  PubMed  Google Scholar 

  15. van Langenberg, D.R., et al., The burden of inpatient costs in inflammatory bowel disease and opportunities to optimize care: a single metropolitan Australian center experience. J Crohns Colitis, 2010. 4(4): p. 413–21.

    Article  PubMed  Google Scholar 

  16. Dotson, J.L., et al., Racial disparities in readmission, complications, and procedures in children with Crohn's disease. Inflamm Bowel Dis, 2015. 21(4): p. 801–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nguyen, G.C., et al., Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection. Inflamm Bowel Dis, 2007. 13(11): p. 1408–16.

    Article  PubMed  Google Scholar 

  18. Nguyen, G.C., et al., Racial and geographic variations in colectomy rates among hospitalized ulcerative colitis patients. Clin Gastroenterol Hepatol, 2006. 4(12): p. 1507–1513.

    Article  PubMed  Google Scholar 

  19. Tsai, T.C., E.J. Orav, and K.E. Joynt, Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care. Ann Surg, 2014. 259(6): p. 1086–90.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kerwel, T.G., et al., Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors. Dis Colon Rectum, 2014. 57(1): p. 98–104.

    Article  PubMed  Google Scholar 

  21. Lucas, D.J., et al., Assessing readmission after general, vascular, and thoracic surgery using ACS-NSQIP. Ann Surg, 2013. 258(3): p. 430–9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Merkow, R.P., et al., Underlying reasons associated with hospital readmission following surgery in the United States. JAMA, 2015. 313(5): p. 483–95.

    Article  CAS  PubMed  Google Scholar 

  23. Sewell, J.L. and F.S. Velayos, Systematic review: The role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis, 2013. 19(3): p. 627–43.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Goldman, C.D., et al., Clinical and operative experience with non-Caucasian patients with Crohn's disease. Dis Colon Rectum, 1986. 29(5): p. 317–21.

    Article  CAS  PubMed  Google Scholar 

  25. Simsek, H. and B.M. Schuman, Inflammatory bowel disease in 64 black patients: analysis of course, complications, and surgery. J Clin Gastroenterol, 1989. 11(3): p. 294–8.

    Article  CAS  PubMed  Google Scholar 

  26. Sofia, M.A., et al., Clinical presentation and disease course of inflammatory bowel disease differs by race in a large tertiary care hospital. Dig Dis Sci, 2014. 59(9): p. 2228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Finlay, D.G., D. Basu, and J.H. Sellin, Effect of race and ethnicity on perceptions of inflammatory bowel disease. Inflamm Bowel Dis, 2006. 12(6): p. 503–7.

    Article  PubMed  Google Scholar 

  28. Birkmeyer, N.J., et al., Socioeconomic status and surgical mortality in the elderly. Med Care, 2008. 46(9): p. 893–9.

    Article  PubMed  Google Scholar 

  29. Basu, D., et al., Impact of race and ethnicity on inflammatory bowel disease. Am J Gastroenterol, 2005. 100(10): p. 2254–61.

    Article  PubMed  Google Scholar 

  30. Nguyen, G.C., et al., Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease. Inflamm Bowel Dis, 2009. 15(8): p. 1233–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wong, M.S., K.A. Gudzune, and S.N. Bleich, Provider communication quality: influence of patients' weight and race. Patient Educ Couns, 2015. 98(4): p. 492–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. May, F.P., et al., Racial Minorities Are More Likely Than Whites to Report Lack of Provider Recommendation for Colon Cancer Screening. Am J Gastroenterol, 2015.

  33. Paquette, I.M., et al., Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum, 2013. 56(8): p. 974–9.

    Article  PubMed  Google Scholar 

  34. Messaris, E., et al., Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum, 2012. 55(2): p. 175–80.

    Article  PubMed  Google Scholar 

  35. Nagle, D., et al., Ileostomy pathway virtually eliminates readmissions for dehydration in new ostomates. Dis Colon Rectum, 2012. 55(12): p. 1266–72.

    Article  PubMed  Google Scholar 

  36. Kulaylat, A.N., et al., Impact of smoking on the surgical outcome of Crohn's disease: a propensity-score matched NSQIP analysis. Colorectal Dis, 2015.

  37. Chu, D.I., et al., Surgical site infections (SSIs) after stoma reversal (SR): risk factors, implications, and protective strategies. J Gastrointest Surg, 2015. 19(2): p. 327–34.

    Article  PubMed  Google Scholar 

  38. Baucom, R.B., et al., Smoking as dominant risk factor for anastomotic leak after left colon resection. Am J Surg, 2015.

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Author information

Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB427, 1720 2nd Avenue South, UAB, Birmingham, AL, 35294-0016, USA

    Drew J. Gunnells Jr., Melanie S. Morris, Aerin DeRussy, Allison A. Gullick, Jamie A. Cannon & Daniel I. Chu

  2. Division of Gastroenterology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Talha A. Malik

  3. Department of Surgery, Stanford University, Stanford, CA, USA

    Mary T. Hawn

Authors
  1. Drew J. Gunnells Jr.
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  2. Melanie S. Morris
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  3. Aerin DeRussy
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  4. Allison A. Gullick
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  5. Talha A. Malik
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  6. Jamie A. Cannon
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  7. Mary T. Hawn
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  8. Daniel I. Chu
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Correspondence to Daniel I. Chu.

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All authors contributed to the conception and design, data analysis/interpretation, and drafting/final approval of the publication.

Appendix A

Appendix A

Table 5 Definition of complication categories
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Gunnells, D.J., Morris, M.S., DeRussy, A. et al. Racial Disparities in Readmissions for Patients with Inflammatory Bowel Disease (IBD) After Colorectal Surgery. J Gastrointest Surg 20, 985–993 (2016). https://doi.org/10.1007/s11605-015-3068-9

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  • DOI: https://doi.org/10.1007/s11605-015-3068-9

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