Impact of Preoperative Factors in Patients with Inflammatory Bowel Disease (IBD) on Length of Stay: An IBD-NSQIP Collaborative Analysis

AbstractBackground and AimsReadmission within 30 days in inflammatory bowel disease (IBD) patients increases treatment costs and serves as a quality indicator. The LACE (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency Department visits in past 6 months) index is used to predict the risk of unplanned readmission within 30 days. The aim of this study was to evaluate the accuracy of using the LACE index in IBD.MethodsCalculation of LACE index was done prospectively for IBD patients admitted to a single tertiary care center. Patient, disease, and treatment characteristics, as well as index hospitalization characteristics including indication for admission and disease activity measures were retrospectively recorded. Descriptive statistics and univariable exact logistic regression analyses were performed.ResultsIn total, 64 IBD patients were admitted during the study period. The 30-day readmission rate of IBD patients was 19% and overall median LACE index was 6, with IQR 6–7. LACE index categorized 16% of IBD patients in low-risk group, 82% in moderate risk group, and 2% in high-risk group. LACE index did not predict 30-day readmission (OR 1.35, CI: 0.88–2.18, P = 0.19). There was no significant difference in 30-day readmission rates with inpatient antibiotic or narcotic use, admission C-reactive protein (CRP), anemia, IBD duration, maintenance therapy, or prior IBD operation. For every 1 day increase in length of stay (LOS), patients were 8% more likely (OR: 1.08, 95% CI: 1.00–1.16) to be readmitted within 30 days (P = .05).ConclusionsLACE index does not accurately identify 30-day readmission risk in the IBD population. As increased LOS is associated with higher risk, there may be benefit for targeted strategic resource allocation via specialized services.

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P806 Impact of patient age, gender and season of admission on length of stay in hospital for acute inflammatory bowel disease admissions

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjy222.930 ◽

2019 ◽

Vol 13 (Supplement_1) ◽

pp. S525-S525

Author(s):

A Yadav ◽

M Unal ◽

P R Armstrong ◽

M N Fauzi ◽

A Tony ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Length Of Stay ◽

Bowel Disease ◽

Patient Age ◽

Patient Âgé ◽

Inflammatory Bowel

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Increased Mortality and Length of Stay Among Patients With Inflammatory Bowel Disease and Hospital-Acquired Infections: Effect of Risk Adjustment

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2011.01.001 ◽

2011 ◽

Vol 9 (5) ◽

pp. 446 ◽

Cited By ~ 1

Author(s):

Lena B. Palmer ◽

Spencer D. Dorn

Keyword(s):

Inflammatory Bowel Disease ◽

Length Of Stay ◽

Risk Adjustment ◽

Bowel Disease ◽

Hospital Acquired Infections ◽

Inflammatory Bowel ◽

Hospital Acquired

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Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02606-13 ◽

2014 ◽

Vol 58 (9) ◽

pp. 5054-5059 ◽

Cited By ~ 30

Author(s):

Henry A. Horton ◽

Seper Dezfoli ◽

Dror Berel ◽

Julianna Hirsch ◽

Andrew Ippoliti ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Clostridium Difficile ◽

Length Of Stay ◽

Bowel Disease ◽

Standard Of Care ◽

Inclusion Criteria ◽

Content Type ◽

Lengths Of Stay ◽

Inflammatory Bowel

ABSTRACTPatients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD), have worse outcomes withClostridium difficileinfection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%;P= 0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P< 0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%;P= 0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P= 0.04]; length of stay, 13.62 days versus 6.38 days [P= 0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.

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Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay

Inflammatory Bowel Diseases ◽

10.1097/mib.0000000000001267 ◽

2017 ◽

Vol 23 (12) ◽

pp. 2189-2196 ◽

Cited By ~ 4

Author(s):

Edward L. Barnes ◽

Bharati Kochar ◽

Millie D. Long ◽

Christopher F. Martin ◽

Michael D. Kappelman

Keyword(s):

Inflammatory Bowel Disease ◽

Length Of Stay ◽

Bowel Disease ◽

Pediatric Patients ◽

Inflammatory Bowel

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P815 Are hospitalised patients with inflammatory bowel disease at increased risk of invasive bacterial infections? Results from POLIBD 2-year cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.943 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S635-S635

Author(s):

R Filip ◽

J Gruszecka

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Length Of Stay ◽

Bowel Disease ◽

Bacterial Infections ◽

Coagulase Negative Staphylococcus ◽

Beta Lactam ◽

Hospitalised Patients ◽

Increased Risk ◽

Inflammatory Bowel

Abstract Background The disease itself as well as immunomodulatory and biological therapy are risk factors for invasive bacterial infections in patients with inflammatory bowel disease (IBD). However, there are limited data on risk factors for bacteraemia in the general population of hospitalised patients with inflammatory bowel disease. The aim of the study was to assess the rate of bacteraemia in hospitalised patients with Inflammatory Bowel Disease and risk factors. Methods An observational cohort of hospitalised patients with Inflammatory Bowel Disease, aged 23–65 years, from 2017 to 2019 in a large tertiary hospital localised in Rzeszow (south-eastern Poland). Patients with one or more positive blood culture were reviewed. Those with Carlson comorbidity index of 2 or greater were excluded. Basic descriptive statistic and logistic regression to evaluate risk factors for bacteraemia were used. Results Of 727 admitted patients, only 1.24% had bacteraemia (9/727) (8, Crohn’s Disease; 1, Ulcerative Colitis). The most common pathogens were Staphylococcus epidermidis (MRCNS - methicillin-resistant coagulase-negative Staphylococcus - strain resistant to all beta-lactam antibiotics: penicillins, penicillins with a B-lactamase inhibitor, cephalosporin and carbapenem) (4/9 patients) and Escherichia coli (3/9 patients). The mortality rate at 30 days of patients with bacteraemia was 0% (no deaths in IBD patients with bacteraemia observed). Longer hospitalisation (mean length of stay for patients with CD was 42 ± 33 vs. 7.95 ± 17.3, p <0.001; mean length of stay for a patient with UC 15 ± 23 vs. 6.25 ± 15.4, p = 0.004) was associated with an increased risk of bacteraemia. Older age was not associated with an increased risk of bacteraemia (P>0.05). In multivariate analysis, treatment with either anti-tumour necrosis factor α, purine analogues, steroids or amino salicylates was not associated with an increased risk of bacteraemia. Conclusion Prolonged hospitalisation, but not Inflammatory Bowel Disease-related treatment, is associated with an increased risk of bacteraemia in hospitalised patients with Inflammatory Bowel Disease.

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