Abstract
Background
Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last decades with the widespread use of biologic medications. However, the overall impact of biologic therapy on PIBD outcomes (specifically hospitalizations, comorbidities, surgical rates, and postoperative complications) remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in outcomes over the last decade. We hypothesized that morbidity in pediatric IBD has decreased over time with the increased use of biologic therapy.
Methods
The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn’s disease (CD) or ulcerative colitis (UC) from 2002–2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and post-operative complications were examined using joinpoint regression analysis.
Results
There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%, 95%confidence interval [CI] 4.7, 7.2) and UC (AAPC 7.2%, 95% CI 6.2, 8.1). The rate of intestinal resection decreased in CD patients (AAPC -6.4%, 95%CI, -8.7, -4.1) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%, 95%CI, 4.6, 9.0). For pediatric UC patients, postoperative complications (AAPC 6.7%, 95%CI, 1.2, 12.4), and comorbidities (AAPC 10.2%, 95%CI, 8.8–11.6) increased significantly over time while intestinal resection rates remained stable.
Conclusions
Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Annual incidence of hospitalization and comorbidities continue to increase in PIBD despite the increased availability and use of biologic medications. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population.
Annual Incidence of Hospitalization for Nonfatal Firearm-Related Injuries in New York From 2005 to 2016
