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P254 Use of immunomodulators reduces early readmission in patients admitted to hospital with an acute flare of inflammatory bowel disease.

J. Kennedy*, D. Tate, E. Turner-Moss, M. Lockett

North Bristol NHS Trust, Gastroenterology, Bristol, United Kingdom

Background

Acute exacerbations of inflammatory bowel disease carry a negative prognosis for the patient and their disease trajectory, and significantly increase costs to the healthcare system. Immunomodulators have been shown previously to be the initial treatment of choice for maintenance of remission in Crohn's disease and ulcerative colitis [1], but are only sporadically prescribed in the initial hospitalization of a patient with IBD exacerbation or new diagnosis of IBD.

Methods

We analysed the case notes of all patients admitted to Southmead Hospital, Bristol during 2014 with a flare or new diagnosis of IBD (identified via coding data as codes K50 or K51). We identified a number of factors associated with the patients' admission and sought to identify those which predicted admission, length of stay and 30 day readmission rates.

Results

54 patients were identified that matched the selection criteria. The mean age was 43.7 years (range 17 to 85). 24 males and 30 females were identified. The median length of stay was 10 days (range 2-69). 36 had Crohn's disease and 18 ulcerative colitis.

Younger patients were more likely to be admitted with terminal ileal Crohn's disease (p=0.001) and indeed this diagnosis represented 30% of all admissions with an IBD flare.

Immunomodulator prescription in hospital was the most significant predictor of no readmission at 30 days (p=0.002). This was particularly significant in Crohn's disease with only 3/22 patients who were taking an immunomodulator being readmitted. There was no significant association of biologic use (p=0.361), steroid use (p=0.358) or surgery (p=0.621) with 30 day readmission.

Length of stay was shorter in patients admitted to a specialist gastroenterology ward (p=0.005), and significantly more patients on a gastroenterology ward received steroid therapy (p=0.048).

Conclusion

We present a real-world snapshot of admissions with acute inflammatory bowel disease to a large district general hospital. Of particular interest is the observation that immunomodulator therapy is strongly associated with no readmission at 30 days. This is plausible given the role of these drugs in maintenance of disease remission. The resultant message to clinicians is clear; the use of an immunomodulator as early as possible during the index admission of a patient admitted with a flare of IBD has the potential to reduce the burden of morbidity and associated healthcare costs from IBD flares.

[1] Dignass. A. et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 2: Current management. Journal of Crohn's and Colitis (2012) 6, 991-1030