Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence

Abstract

INTRODUCTION: Despite the recent emergence of expensive biologic therapies, hospitalization and surgery remain important contributors for the overall costs of inflammatory bowel disease (IBD). In this study, we aimed to describe the burden of reoperations in patients with IBD by evaluating reoperation rates, charges, and risk factors over 16 years. METHODS: We performed a retrospective analysis of all hospital discharges, with focus on reoperations and with a primary diagnosis of IBD, in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System's national registry. We collected data on patient, clinical, and healthcare charges. We used multivariate regressions to estimate the risk factors of IBD-related reoperations. RESULTS: We found that 5% of IBD-related hospitalizations were related to reoperations. The number of reoperations per year increased by approximately 200%. However, when corrected by the prevalence of the disease, IBD reoperation rates decreased. Mean IBD-related charges per hospitalization were 7,780 € in 2000 and 10,592 € in 2015, with total charges reaching 6.7 million euros by the end of the study. Risk factors for reoperation include urgent hospitalization, in patients with ulcerative colitis (odds ratio 1.94, 95% confidence interval 1.19–3.17, P = 0.008), and colic disease, in patients with Crohn's disease (odds ratio 1.57, 95% confidence interval 1.06–2.34, P = 0.025). DISCUSSION: To obtain an accurate scenario of reoperations among patients with IBD, it is mandatory to adjust the number of reoperations to the prevalence of the disease. Reoperation and its risk factors should be closely monitored to decrease the burden of IBD to the healthcare system.

Crossing barriers: the burden of inflammatory bowel disease across Western Europe

“…Interestingly, Portugal is the only country to document an increase in IBD-related surgical procedures, with a shift towards elective surgery. 43 , 44 However, they found that IBD re-operation rates had actually decreased when corrected for disease prevalence. The cause for this remains unclear due to the lack of published data although it is postulated that the main contributing factors are the rising disease prevalence, delayed diagnoses of CD leading to more complex and complicated disease and the European guidelines recommending elective surgery when possible and early surgical interventions for the more complicated cases.…”

Panorama Epidemiológico De Internação Das Doenças Inflamatórias Intestinais No Estado Do Rio De Janeiro Nos Últimos Cinco Anos

“…Os sintomas gastrointestinais se manifestam como dor abdominal, dispepsia, diarréia, incontinência fecal, constipação e inchaço, podendo perdurar até mesmo durante o tratamento regular da doença 17 . Na vigência de complicações agudas, é necessário tratamento de urgência, podendo ser devido a abscessos intra-abdominais, colite causada por Clostridium e Citomegalovírus, alterações motoras do trânsito intestinal (como megacólon tóxico), hemorragia intestinal, obstrução intestinal e perfuração 18 .…”