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P620 Pivoting in a pandemic: The impact of COVID-19 on the provision of care for patients with Inflammatory Bowel Disease – A retrospective study

Malhi, G.(1);Chambers, J.(1);Minhas, G.(1);Mikail, M.(1);Khanna, R.(2);Wilson, A.(3);

(1)Western University, Medicine, London, Canada;(2)Western University, Division of Gastroenterology, London, Canada;(3)Western University, Physiology & Pharmacology- Divisions of Clinical Pharmacology- and Gastroenterology, London, Canada

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, also known as COVID-19, initially began in a small cluster of patients in Wuhan, China and was declared a worldwide pandemic in March of 2020.  Since the onset of the pandemic, the focus of many healthcare systems has shifted toward limiting non-essential visits to the hospital in order to prioritize and allocate resources toward treating those affected by COVID-19.  While the effect of COVID-19 has been felt amongst many patient populations, those with Inflammatory Bowel Disease (IBD) have been particularly impacted.  We aimed to determine how changes to the provision of IBD care due to the COVID-19 pandemic has affected IBD patients.

Methods

A retrospective cohort study was carried out in patients with an IBD diagnosis comparing patients admitted to two tertiary care centres affiliated with Western University in London, Canada between March 17 and August 31 2019 (2019 cohort or pre-pandemic), to patients admitted between March 17 and August 31 2020 (2020 cohort or pandemic).  Patients were reviewed to assess any differences in care utilization and IBD-related outcomes such as hospitalization, need for surgery, length of stay in hospital and in-patient drug therapy during the defined time periods.

Results

A total of 863 patients were reviewed in 2019, and 554 in 2020. Of those, 184 (CD, n= 125; UC, n= 59) and 172 (CD, n= 109; UC, n= 62) encounters met the inclusion criteria for 2019 and 2020 respectively. Patient demographics were similar between 2019 and 2020 cohort with the exception of age (2019, mean age = 44.76 years ± 16.78; 2020, mean age=50.36 years ± 17.82, p=0.002).  The length of stay in hospital was shorter in 2020 (6.88 days vs 9.63, p=0.045).  Significantly fewer patients were initiated on Infliximab in hospital in 2020 (2020, 3.50 per month; 2019, 6.83 per month, p=0.001).  Fewer in-patient surgeries were performed in 2020 (2019, 76; 2020, 57; p=0.112).

Conclusion

Preliminary data demonstrate during the COVID-19 pandemic there was a significant reduction in the length of stay for patients with IBD as well as fewer patients initiated on infliximab while in hospital.  There was also a decrease in the number of surgeries performed in 2020.  These differences may reflect an effort to minimize contact between patients and health care facilities as well as reduce the introduction of further immunosuppression. Further research will be to determine whether if more ER visits became hospitalizations and any delays in appointment times or endoscopies, or compliance issues with medications may have led to these aforementioned outcomes.

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