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P497 Surgery and hospitalization in inflammatory bowel disease - what has changed in the last 25 years? - Overview of clinical practice in a tertiary referral center

P. Sousa*1, P. Santos1, S. Fernandes1, C. Moura1, C. Baldaia1, A. Gonçalves1, P. Moura Santos1, N. Fatela1, A. Valente1, F. Serejo1, J. Malaquias2, L. Correia1, J. Velosa1

1Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal, 2Centro Hospitalar Lisboa Norte, Surgery, Lisbon, Portugal

Background

Crohn's Disease (CD) and Ulcerative Colitis (UC) are subtypes of Inflammatory Bowel Disease (IBD) often requiring both medical and surgical management. Anti-TNF drugs have represented a major breakthrough in the medical treatment of moderate to severe UC and CD. More than half of IBD patients will require surgery during their lifetime. Therefore, both hospitalization and surgery are important outcomes and major drivers of healthcare costs in these patients.

Our aim was to evaluate the changes in number and length of hospitalizations and surgical procedures in IBD patients after the introduction of anti-TNF therapy in 2005.

Methods

Retrospective study of patients with CD and UC followed in a tertiary referral center over a period of 25 years (July 1989- October 2014). Patients were divided into two cohorts: patients admitted to hospitalization before 2005 (A) and after 2005 (B). Endpoints included number and length of hospitalizations and surgeries. Statistical analysis was performed with SPSS v 20.0 IBM statistics.

Results

During the follow-up time there were a total of 5541 hospitalizations - 3662 (66%) in CD and 1879 (34%) in UC, averaging 222 hospitalizations per year. These included 2298 patients - 1365 (59%) with CD and 933 (41%) with UC. The number of hospitalizations increased over time: 2483 (44.8%) in cohort A and 3058 (55.2%) in cohort B. However, the mean length of hospitalizations slightly decreased (10.4 ± 14.5 days versus 9.5 ± 15.4 days, p= 0.029). There was no statistically significant difference when comparing patients with CD and UC separately (9.5 ± 14.0 days versus 8.8 ± 14.4 days, p = 0.149 and 12.1 ± 15.24 versus 11.1 ± 17.35 days, p = 0.173, respectively). Patients with UC had longer lengths of hospitalization (11.5 ± 16.4 versus 9.1 ± 14.2 days, p=0.0001).

During this time period 593 surgeries were performed: 338 (57%) in the last ten years, averaging 23 per year.

The length of hospitalization in patients admitted for surgical procedures was significantly different between the two time cohorts (21.2 ± 21.3 versus 17.8 ± 17.5 days, p=0.038).

Conclusion

In our series, there was a clear tendency for an increase in the number of hospitalizations and surgeries in the last ten years in both patients with UC and CD. However, the length of hospitalizations was significantly shorter. Interestingly the length of hospitalizations were longer in patients with UC.

Possible reasons for these results are explained by both an increased awareness of IBD and the introduction of both immunomodulation and anti-TNF therapy.