Impact of inflammatory bowel disease on urologic oncology surgical outcomes and costs of care.

470 Background: Recent studies suggest an association between genitourinary malignancies and inflammatory bowel disease (IBD). Our objective was to investigate clinical and financial impacts of IBD on common major urologic cancer surgeries: radical prostatectomy (RP), radical cystectomy (RC), radical nephrectomy (RN), and partial nephrectomy (PN). Methods: Using ICD9 codes, the Premier Hospital Database was queried for patients who underwent one of four surgeries: RP, RC, RN, or PN from 2003 to 2015. The cohort was segregated into IBD patients and non-IBD patients. Multivariable logistic regression models were used to determine the independent impact of IBD on complication rates (by Clavien-Dindo classification and organ system) and readmission rates. Hospital cost differences between the two cohorts, adjusted to 2016 US dollars, were examined with multivariable quantile regression models. Results: Our study population included 220,192 patients with urological malignancies, 5165 (0.4%) of whom had IBD. After controlling for clinicodemographic variables, there were significantly higher odds for any complication (Clavien ≥1) for IBD patients compared to non-IBD controls for RC (Odds ratio [OR]: 3.04, 95% confidence interval [CI]: 1.25-7.43), RN (OR: 1.57, 95% CI: 1.1-2.23), and PN (OR: 1.5, 95% CI: 1.02-2.22). Specifically, IBD patients had significantly more gastrointestinal, infectious, and soft tissue complications. Readmission rates were significantly higher for IBD patients who underwent RC (OR: 2.50, 95% CI: 1.17-5.35) and PN (OR: 1.81, 95% CI: 1.17-2.80). Hospital costs were significantly elevated for IBD patients, ranging from +$893 (95% CI: 108-1677) to +$6261 (95% CI: 1861-10660). Conclusions: There was a significantly higher overall complication rate for IBD patients undergoing RC, RN, or PN compared to the non-IBD cohort. Hospital readmission rates were significantly higher for the IBD cohort who underwent RC and PN. Hospital costs associated with surgery were also increased for IBD patients. These findings may be important when counseling IBD patients about surgical outcomes and during development of enhanced recovery pathways or bundled payment programs.

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Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.230 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 230-230

Author(s):

Ilana Goldberg ◽

Steven Lee Chang ◽

Shilajit Kundu ◽

Benjamin I. Chung ◽

Eric A. Singer

Keyword(s):

Prostate Cancer ◽

Inflammatory Bowel Disease ◽

Radical Prostatectomy ◽

Surgical Approach ◽

Bowel Disease ◽

Regression Models ◽

Complication Rates ◽

Readmission Rates ◽

Surgical Costs ◽

Inflammatory Bowel

230 Background: Recent studies suggest an association between prostate cancer and inflammatory bowel disease (IBD). Our objectives were to investigate clinical and financial impacts of IBD on radical prostatectomy (RP), and to determine the impact of surgical approach on our findings. Methods: The Premier Hospital Database was queried for patients who underwent RP from 2003 to 2017. Multivariable logistic regression models were used to determine the independent impact of IBD on complications and readmission rates. We determined 90-day readmissions and examined 90-day hospital costs adjusted to 2019 US dollars with multivariable quantile regression models. Results: Our study population included 262,189 men with prostate cancer, including 3,408 (1.3%) with IBD. There were higher odds for any complication for IBD patients compared to non-IBD controls for RP (15.64% vs. 10.66%). IBD patients had overall complication rates of 14.1% ( P < 0.05) for open surgery and 17.2% for MIS ( P < 0.01). Between 2013-2017, the IBD cohort had significantly more complications (OR: 2; 95% CI: 1.5 to 2.67; P < 0.0001), was more likely to have surgical costs in the top quartile (OR: 1.6; 95% CI: 1.23 to 2.1; P < 0.01), and had higher readmission rates (OR: 1.51; 95% CI: 1.1 to 2.06; P = 0.01). Conclusions: The IBD cohort who underwent MIS had the highest complication rates. Hospital readmissions and surgical costs were significantly higher for the IBD cohort who underwent RP between 2013-2017, when a minimally invasive approach was more prevalent than an open approach. These findings may be important when deciding which surgical approach to take when performing RP on men with IBD. [Table: see text]

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Do Patients With Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz172 ◽

2019 ◽

Vol 26 (3) ◽

pp. 476-483 ◽

Cited By ~ 4

Author(s):

David Liska ◽

Turgut Bora Cengiz ◽

Matteo Novello ◽

Alexandra Aiello ◽

Luca Stocchi ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Multivariate Analysis ◽

Bowel Disease ◽

Enhanced Recovery ◽

Hospital Costs ◽

Estimated Blood Loss ◽

Enhanced Recovery Pathways ◽

Inflammatory Bowel ◽

Outpatient Operations ◽

Recovery Pathways

Abstract Background Enhanced recovery pathways (ERPs) have been shown to reduce length of stay (LOS), complications, and costs after colorectal surgery; yet, little data exists regarding patients with inflammatory bowel disease (IBD). We hypothesized that implementation of ERP for IBD patients is associated with shorter LOS and improved economic outcomes. Methods An IRB-approved prospective clinical database was used to identify consecutive patients from 2015 to 2017. Patients were grouped as “pre-ERP” and “post-ERP” based on the date of implementation of a comprehensive ERP. Ileostomy closures, redo pouch operations, and outpatient operations were excluded. The relationship between ERP, LOS, and secondary outcomes was assessed using univariate and multivariate analysis. Results Overall, a total of 671 patients were included: 345 (51.4%) with Crohn’s disease (CD) and 326 (48.6%) with ulcerative colitis (UC). Of these, 425 were pre-ERP (63.4%), and 246 were post-ERP (36.6%). The groups did not differ in terms of age, gender, American Society of Anesthesiologist (ASA) scores, comorbidities, estimated blood loss, or ostomy construction. The post-ERP group had a significantly higher mean body mass index (BMI), more patients with CD, longer operative time, and more minimally invasive surgery (MIS; all P < 0.05). The post-ERP group had a significantly shorter LOS (6 vs 4.5 days, median), whereas mean hospital costs decreased by 15.7%. There was no difference in readmissions or complications. On multivariate analysis, MIS and ERP use were both associated with a shorter LOS. Conclusion Inflammatory bowel disease patients benefit from the use of ERP, demonstrating decreased LOS and costs without an increase in complications and readmissions. Enhanced recovery pathways should be routinely implemented in this often challenging patient population.

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Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease (IBD)

The American Journal of Surgery ◽

10.1016/j.amjsurg.2020.12.010 ◽

2020 ◽

Author(s):

Isabel C. Dos Santos Marques ◽

Lauren M. Theiss ◽

Lauren N. Wood ◽

Drew J. Gunnells ◽

Robert H. Hollis ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Racial Disparities ◽

Bowel Disease ◽

Surgical Outcomes ◽

Inflammatory Bowel

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Sarcopenia as an independent predictor of the surgical outcomes of patients with inflammatory bowel disease: a meta-analysis

Surgery Today ◽

10.1007/s00595-019-01893-8 ◽

2019 ◽

Vol 50 (10) ◽

pp. 1138-1150 ◽

Cited By ~ 4

Author(s):

Adrienn Erős ◽

Alexandra Soós ◽

Péter Hegyi ◽

Zsolt Szakács ◽

Márton Benke ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Postoperative Complications ◽

Early Detection ◽

Confidence Interval ◽

Bowel Disease ◽

Surgical Outcomes ◽

Independent Predictor ◽

Meta Analysis ◽

Random Effects Models ◽

Inflammatory Bowel

Abstract Patients with inflammatory bowel disease (IBD) are at risk of sarcopenia, which is associated with poor clinical outcomes. We conducted this study to assess whether sarcopenia predicts the need for surgery and postoperative complications in patients with IBD. We performed a systematic search of four electronic databases, last updated in March, 2019. Data from studies comparing rates of surgery and postoperative complications in sarcopenic IBD patients versus non-sarcopenic IBD patients were pooled with the random-effects models. We calculated the odds ratios (OR) with a 95% confidence interval (CI). Ten studies with a collective total of 885 IBD patients were included in our meta-analysis. Although the analysis of raw data did not reveal significant differences between the two groups with respect to the rate of surgery and postoperative complications (OR = 1.826; 95% CI 0.913–3.654; p = 0.089 and OR = 3.265; 95% CI 0.575–18.557; p = 0.182, respectively), the analysis of adjusted data identified sarcopenia as an independent predictor for both of the undesirable outcomes (OR = 2.655; 95% CI 1.121–6.336; p = 0.027 and OR = 6.097; 95% CI 1.756–21.175; p = 0.004, respectively). Thus, early detection of sarcopenia in patients with IBD is important to prevent undesirable outcomes.

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