P265 Evaluation of the quality-of-care parameters in patients with inflammatory bowel disease in Brazilian hospitals
VilelaVilela, E.(1)*;Serafim Parra, R.(2);Yukie Sassaki, L.(3);da Costa Ferreira, S.(2);Araújo Lisboa, R.(4);Oliveira Santana, G.(4);Luiz Parente, J.M.(5);Cassol, O.(6);Gustavo Kotze, P.(7);Pereira Westphalen, A.(8);Zaltman, C.(9);Marques dos Santos, C.H.(10);Hamer Sousa Clara, A.P.(11);Lovatti, R.(12);de Assis Gonçalves Filho , F.(13);Vieira, A.(14);Filardi Simiqueli Durante , R.(15);Bafutto, M.(16);Botelho Quaresma, A.(17);de Freitas Lins Neto, M.Á.(18);Barrio Bortoli , Z.(15);Coelho Ludvig, J.(19); Machado de Souza , M.(20);Freire, C.(21);Martinelli, V.(22);Antunes de Brito, C.A.(23);Pandolfo Zabot, G.(24); Medeiros Soares Celani, L.(25); Mônica de Oliveira Leite, S.(26);Saad Hossne, R.(3);
(1)Universidade Federal de Minas Gerais, Alfa Institute of Gastroenterology, Belo Horizonte, Brazil;(2)Universidade de São Paulo, Hospital das Clínicas, Ribeirão Preto, Brazil;(3)Universidade do Estado de São Paulo, Hospital das Clínicas, Botucatu, Brazil;(4)Hospital Geral Roberto Santos, Gastroenterologia, Salvador, Brazil;(5)Universidade Federal do Piauí, Hospital Universitário, Teresina, Brazil;(6)Hospital de Clínicas de Passo Fundo, Proctologia, Passo Fundo, Brazil;(7)Hospital Marcelino Champagnat, Proctologia, Curitiba, Brazil;(8)Hospital Universitário do Oeste do Paraná, Proctologia, Cascavel, Brazil;(9)Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil;(10)Universidade Federal do Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, Brazil;(11)Hospital Santa Casa De Misericórdia de Vitória, Gastroenterologia, Vitória, Brazil;(12)Hospital Márcio Cunha, Gastroenterologia, Ipatinga, Brazil;(13)Hospital de Base, Proctologia, São José do Rio Preto, Brazil;(14)Santa Casa de Misericórdia de São Paulo, Gastroenterologia, São Paulo, Brazil;(15)Hospital Brasília, Gastroenterologia, Brasília, Brazil;(16)Universidade Federal de Goiás, Hospital das Clínicas, Goiânia, Brazil;(17)Hospital São Miguel, Proctologia, Joaçaba, Brazil;(18)Universidade Federal de Alagoas, Hospital Universitário Professor Alberto Antunes, Maceió, Brazil;(19)Hospital Santa Isabel, Gastroenterologia, Blumenau, Brazil;(20)Universidade Federal do Mato Grosso, Hospital Júlio Müller, Cuiabá, Brazil;(21)Hospital Geral Dr. César Cals, Gastroenterologia, Fortaleza, Brazil;(22)Universidade Federal de Pernambuco, Hospital das Clinicas UFPE, Recife, Brazil;(23)Universidade Federal de Pernambuco, Hospital das Clínicas, Recife, Brazil;(24)Hospital Moinhos de Vento, Proctologia, Porto Alegre, Brazil;(25)Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Natal, Brazil;(26)Hospital Governador Israel Pinheiro, Proctologia, Belo Horizonte, Brazil; GEDIIB - Brazilian Organization of Cronh´s disease and Colitis
There are few data on the quality-of-care for inflammatory bowel disease (IBD) in public, private or mixed hospitals, especially in Latin America. The aim of the study was to evaluated clinic and quality parameters and their association with need for ICU and death in Brazilian hospitals.
This was a multicentre study carried out in 26 hospitals. Four hundred eighty-eight admissions of patients with IBD were analysed between June 2021 and October 2022.
The median stay length was 6 days (0–121). The median age was 38 years (16–87), and 265 (54.6%) were female. Three hundred and thirty-nine patients (69.5%) had Crohn's disease (CD) and 149 (30.5%) ulcerative colitis (UC). The median time between symptoms onset and hospital admission was 72 months (1-504) in CD and 49 months (1-300) in UC. In the CD group, there was structural damage in 248 cases (73.2%). UC in pancolitis form was seen in 97 (66%). The Charlson Comorbidity Index (CCI) was scored at least at one point in 182 records (37.3%), and the median was 2 (1-17). Three hundred-seven admissions (62.9%) were urgent, and 208 cases (42.6%) remained in the emergency room (ER) for 2 days (1-22). Disease activity and structural damage accounted for 58.6% of admissions. One-hundred and eighty-three surgeries were performed (37.5%), and 35 (18.1%) postoperative complications were reported. The most prescribed drugs were biologicals (52.8%) before admission and corticosteroids during hospitalization (37.3%). Red days were verified in 45.3%. Intensive care unit (ICU) admission was required in 55 cases (11.3%). One hundred and nine (22.3%) bacterial infections were registered. There were 16 deaths (3.3%), and the main cause was sepsis (37.5%). Surgery, infection, duration of CD symptoms, and CCI were associated with the need for ICU (p= 0.000; 0.000; 0.043; 0.014, respectively). The CCI of 1 best predicted the need for ICU (AUROC 0.588; S 52.7%, E 64.7%). Infection, age, days in the ER, ICU, and CCI were associated with death (p= 0.004; 0.022; 0.006; 0.000; 0.000, respectively). The CCI of 1 is also the best predicted death (AUROC 0.782; S 81.3%, E 64.2%). The need to stay in ER and red days were lower in private and mixed hospitals (p= 0.000). Infection and death rates were similar (p= 0.323).
A sample with complications associated with IBD but with low CCI due to their younger age was characterized. The majority had CD, and more than 60% of admissions were urgent. The CCI accuracy in predicting ICU and death was obtained. A system deficiency was more evidenced in public hospitals in the rate of individuals who remained in ER. From the red days, greater problem-solving agility was found in private and mixed hospitals.