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As Infliximab Use for Ulcerative Colitis Has Increased, so Has the Rate of Surgical Resection

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Infliximab was approved for ulcerative colitis in 2005 after randomized trials showed it reduced the risk of colectomy. Its effect on population-level surgery rates is unknown. Our aim is to assess the impact of infliximab approval for ulcerative colitis on surgical intervention.

Methods

Retrospective review of a private insurance claims database (2002 to 2013) was performed of patients aged 18–64 diagnosed with ulcerative colitis and with 2 years of follow-up. Outcome measures were infliximab treatment and surgical resection. Multivariable logistic regression used independent variables of time period of diagnosis, age, gender, comorbidities, and insurance type.

Results

The cohort included 58,681 patients. Age, gender, and comorbidities were comparable across time periods. Patients diagnosed in the post-infliximab period had greater odds of undergoing infliximab treatment within the first year of diagnosis than those in the pre-infliximab era (OR = 2.88, p < 0.001). However, the odds of undergoing total colectomy or total proctocolectomy were also higher in patients diagnosed in the post-infliximab period (OR 1.5, p < 0.001).

Conclusions

The use of infliximab for ulcerative colitis has, as expected, increased since its approval, but so has the risk of surgery. Thus, the introduction of biologic therapy has not decreased the risk for surgery for this patient population.

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Acknowledgements

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Author information

Authors and Affiliations

  1. Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA

    Cindy Kin

  2. Department of Health Research & Policy, Stanford University School of Medicine, Stanford, CA, USA

    M. Kate Bundorf

Authors
  1. Cindy Kin
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  2. M. Kate Bundorf
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Contributions

Kin—conception, design, data analysis and interpretation, drafting the article, critical revisions, final approval, and agreement to be accountable for all aspects of the work.

Bundorf—conception, design, data acquisition, analysis and interpretation, critical revisions, final approval, and agreement to be accountable for all aspects of the work.

Corresponding author

Correspondence to Cindy Kin.

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Appendices

Appendix 1: ICD-9 and CPT codes used to identify the cohort of patients newly diagnosed with ulcerative colitis in the MarketScan database, 2003–2012

ICD-9 codes for Diagnoses of Ulcerative Colitis

556.0

ulcerative enterocolitis

 556.1

ulcerative ileocolitis

 556.2

ulcerative proctitis

 556.3

ulcerative proctocolitis

 556.4

left-sided ulcerative colitis

 556.6

universal ulcerative colitis

 556.8

other ulcerative colitis

 556.9

ulcerative colitis, unspecified

CPT codes for Lower Endoscopies

 G0105

screening colonoscopy; high-risk individual

 G0121

screening colonoscopy, not high-risk individual

 45378

diagnostic colonoscopy, with or without collection of specimen

 45380

colonoscopy with biopsy

 45381

colonoscopy with submucosal injection

 45382

colonoscopy with control of bleeding

 45383

colonoscopy with ablation of tumor or polyp

 45384

colonoscopy with removal of tumor

 45385

colonoscopy with removal of tumor

 G0104

flexible sigmoidoscopy for cancer screening

 45330

flexible sigmoidoscopy

 45331

flexible sigmoidoscopy with biopsy

 45334

flexible sigmoidoscopy with control of bleeding

 45448

flexible sigmoidoscopy with removal of polyp

 45333

flexible sigmoidoscopy with polypectomy

 45335

flexible sigmoidoscopy with submucosal injection

Appendix 2: CPT codes used to identify ulcerative colitis-related operations in patients newly diagnosed with ulcerative colitis in the MarketScan database from 2003 to 2012

Total Abdominal Colectomy

 44144

Colectomy with ileostomy and creation of mucus fistula

 44150

Total colectomy with end ileostomy or ileorectal anastomosis

 44210

Laparoscopic total colectomy with ileostomy or ileorectal anastomosis

Total Proctocolectomy with end ileostomy

 44155

Total proctocolectomy with end ileostomy

 44212

Laparoscopic total proctocolectomy with end ileostomy

Total Proctocolectomy with ileal pouch

 44157

Total proctocolectomy with ileoanal anastomosis

 44158

Total proctocolectomy with ileal pouch anal anastomosis

 44211

Laparoscopic total proctocolectomy with ileal pouch anal anastomosis

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Kin, C., Kate Bundorf, M. As Infliximab Use for Ulcerative Colitis Has Increased, so Has the Rate of Surgical Resection. J Gastrointest Surg 21, 1159–1165 (2017). https://doi.org/10.1007/s11605-017-3431-0

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  • DOI: https://doi.org/10.1007/s11605-017-3431-0

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