Increasing Hospitalizations in Inflammatory Bowel Disease Among Children in the United States, 1988–2011

Sandberg, Kelly C.; Davis, Matthew M.; Adler, Jeremy

doi:10.1097/mib.0000000000000195

Cited by 24 publications

(17 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1 Recent studies indicate that hospitalizations are increasing for children with inflammatory bowel diseases (IBD) in the US. 2,3 In addition, a Canadian study demonstrated that pediatric patients with IBD are at greater risk for hospital readmission compared with older patients. 4 These trends are cause for concern to both patients and payers, as hospitalization of pediatric patients with IBD has been associated with a significant cost burden 5–7 and hospitalization has been associated with decreased health-related quality of life in other populations of children with chronic diseases.…”

mentioning

confidence: 99%

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

Barnes

Kochar

Long

et al. 2017

The Journal of Pediatrics

View full text Add to dashboard Cite

Objective To evaluate the burden and predictors of hospital readmissions among pediatric patients with inflammatory bowel disease using the Nationwide Readmissions Database. Study design We performed a retrospective cohort study using 2013 Nationwide Readmissions Database. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients <18 years with diagnoses of ulcerative colitis (UC) or Crohn disease (CD). Demographic factors and details of hospitalizations were evaluated using survey procedures in SAS v 9.4 (SAS Institute, Cary, North Carolina). Multivariable logistic regression was used to estimate ORs and 95% CIs of readmission. Results Among 2733 hospitalizations (63% CD, 37% UC), 611 (22%) patients were readmitted within 90 days of the index hospitalization. Readmission resulted in weighted estimates of 11 440 excess days of hospitalization and total charges of over $107 million. For CD, male sex (aOR 1.36, 95% CI 1.03–1.81) and co-existing anxiety or depression (aOR 1.89, 95% CI 1.06–3.40) were associated with increased readmissions, while patients who underwent surgery had decreased readmissions (aOR 0.40, 95% CI 0.24–0.65). In patients with UC, and index admission of >7 days was associated with increased readmissions (aOR 1.69, 95% CI 1.09–2.62). Conclusions Readmission occurs frequently in children with inflammatory bowel disease and is associated with significant cost and resource burdens. Among patients with CD, psychiatric comorbidities such as anxiety and depression are apparent drivers of readmission.

show abstract

mentioning

confidence: 99%

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

Barnes

Kochar

Long

et al. 2017

The Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…Patients with IBD require more frequent hospital admissions than non-IBD patients, with an increased average length of stay not only in the United States but also globally. 1,2 Moreover, hospital care for IBD patients has been shown to be twice as expensive as that for non-IBD controls. 3 Repeat hospitalization in subgroups of IBD patients seems to be a large part of this issue 4,5 ; however, there is only limited literature examining the characteristics of IBD patients who are associated with frequent hospital use.…”

mentioning

confidence: 99%

Risk Factors for Rehospitalization Within 90 Days in Patients with Inflammatory Bowel Disease

Allegretti

Borges

Lucci

et al. 2015

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Background Care of patients with inflammatory bowel disease (IBD) poses a significant burden to the health-care system. Repeat hospitalization in subgroups of IBD patients seems to be a large part of this issue; however, there are limited data examining the characteristics of these patients. The aim of this study was to characterize admission patterns in patients with IBD at a tertiary-care center and to identify preventable risk factors of 90-day readmission after an index IBD admission. Methods Retrospective analysis was performed extracting data from an electronic medical record over a 2-year period. Results Three hundred fifty-six patients were admitted at least once during the 2-year study period for an unplanned IBD-related reason. Of these, 48.9% were admitted once, 38.2% were admitted 2 to 4 times, and 12.9% were admitted 5 or more times during the study period. Patients with any admission within 90 days before index were excluded; n = 33. One hundred two patients had experienced a readmission by 90 days after index admission. Numerous demographic and medical factors were examined for association with readmission. The final Cox model included 3 variables: depression (HR = 1.99, 1.33–3.00), chronic pain (HR = 1.88, 1.14–3.10), and steroid use in the previous 6 months (HR = 1.33, 0.92–2.04). Conclusions Our findings suggest that patients with depression and chronic pain are at greatest risk for a readmission within 90 days after an initial IBD admission. Disease activity, represented by steroid use in the previous 6 months, was not related to readmission. Addressing these problems in the outpatient setting may reduce future hospitalizations.

show abstract

“…The combination of diagnosis codes used in defining the sample has been described previously. 9,17–19 We excluded discharges with codes of other forms of colitis (eosinophilic, allergic, microscopic, and ischemic) as well as discharges with codes for both CD & UC. Discharges with CDI were captured using the ICD-9-CM code of 008.45; this is the only code devoted to CDI, has been previously validated as an accurate determinant of active CDI.…”

Section: Methodsmentioning

confidence: 99%

“…11 To evaluate trends over time, the P for trend test was conducted using variance-weighted least-squares regression, demonstrated previously. 9,24–26 Trends were analyzed over 1997–2011 as yearly point estimates with 95% confidence intervals.…”

Section: Methodsmentioning

confidence: 99%

“…We have reported elsewhere that overall hospitalizations of pediatric patients with IBD are increasing on a national level. 9 It is unclear how much CDI contributes to this increase. Previous work by Pant, et al indicates that CDI is associated with longer lengths of stay and higher charges compared to hospitalizations of pediatric IBD patients without CDI, and seems to be most pronounced for patients with ulcerative colitis, 10 but in the current body of literature, it is not clear whether the differential burden apparent with CDI has been changing over time.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Disproportionate Rise in Clostridium difficile–Associated Hospitalizations Among US Youth With Inflammatory Bowel Disease, 1997–2011

Sandberg¹,

Davis

Adler³

2015

J. pediatr. gastroenterol. nutr.

Self Cite

View full text Add to dashboard Cite

Objectives Our aim was to characterize the temporal changes in burden that Clostridium difficile infection (CDI) added to the hospital care of children and young adults with inflammatory bowel disease (IBD) in the United States. Methods Retrospective analysis of annual, nationally-representative samples of children and young adults with IBD. Results There was a five-fold increase in IBD hospitalizations with CDI from 1997 to 2011 (P for trend <0.01). Over the same period, IBD hospitalizations without CDI increased two-fold (P for trend <0.01). Mean length of stay (LOS) for IBD hospitalizations with CDI was consistently longer than hospitalizations without CDI and did not significantly change over time (P for trend = 0.47). CDI-related total hospital days in the US rose from 1,702 to 10,194 days per million individuals per year from 1997 to 2011 (P for trend < 0.01). Children and young adults hospitalized with CDI had a significantly lower odds of colectomy (0.31) compared to those without CDI. Total charges for CDI-related hospitalizations among children and young adults in the U.S. rose from $8.7 million in 1997 to $68.2 million in 2011. Conclusions A widening gap in burden has opened between IBD hospitalizations with and without CDI over the last decade and a half. CDI-related hospitalizations are associated with disproportionately longer lengths of stay, more hospital days, and more charges than hospitalizations without CDI over time. Further work within health systems, hospitals, and practices, can help us better understand this enlarging gap to improve clinical care for this vulnerable population.

show abstract

Increasing Hospitalizations in Inflammatory Bowel Disease Among Children in the United States, 1988–2011

Cited by 24 publications

References 50 publications

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

The Burden of Hospital Readmissions among Pediatric Patients with Inflammatory Bowel Disease

Risk Factors for Rehospitalization Within 90 Days in Patients with Inflammatory Bowel Disease

Disproportionate Rise in Clostridium difficile–Associated Hospitalizations Among US Youth With Inflammatory Bowel Disease, 1997–2011

Contact Info

Product

Resources

About