Hospitalization Trends in Inflammatory Bowel Disease Patients With Pouchitis: A Population-Based Study

Abstract

INTRODUCTION Pouchitis is a complication of total colectomy and ileal pouch-anal anastomosis for ulcerative colitis that can lead to hospitalization. We aimed to assess trends of hospitalization rates and health care utilization in patients with pouchitis from 2010 – 2019. METHODS We performed a retrospective cohort study using the National Inpatient Sample database from 2010 to 2019 of hospitalized patients with a primary discharge diagnosis of pouchitis and a secondary diagnosis of inflammatory bowel disease (IBD), or primary diagnosis of IBD and a secondary diagnosis of pouchitis. We compared baseline characteristics and outcomes of patients admitted from 2010-2014 to 2015-2019. The primary outcome was the rate of hospitalization for pouchitis between the two five-year periods. Secondary outcomes included length of hospital stay (LOS) and total hospitalization charges. We applied discharge weights to generate national estimates. RESULTS A total of 8215 hospitalizations with pouchitis were identified for IBD patients, with 3856 hospitalizations in the 2010 – 14 group and 4359 in the 2015- 19 group. The 2015-2019 group had less females (54.54% vs 46.67%, p =0.002) and increased hospitalization in urban teaching hospitals (71.95% vs 85.67%, p< 0.001) (Table 1). Hospitalizations with a primary diagnosis of pouchitis were lower in the 2015-2019 group (58.91% vs 53.21%, p= 0.024). Over the study period (2010-2019), there was a numeric increase in the pouchitis incidence among hospitalized IBD patients (2.68 in 2010 to 2.87 in 2019 per 1000 discharges, p=0.459), and the number of patients undergoing inpatient pouchoscopy (25.67% in 2010 and 26.55% in 2019, p=0.803). The average inflation-adjusted total hospitalization charges were $12,555 higher in 2019 compared to 2010 (p=0.045). However, there was a decrease in LOS over this period (5.99 days in 2010 to 5.39 in 2019, p=0.182) (Figure 1). DISCUSSION Over the past decade, the overall number of hospitalizations for IBD patients with pouchitis remained stable with a slight numeric increase, but the rate of hospitalization primarily for pouchitis has significantly decreased. Although LOS has numerically decreased, the overall cost of hospitalization has increased for IBD patients with pouchitis. This may be partly due to increased endoscopic evaluation performed during more recent years.