Khwaja F. Haq, MD1, Randeep Kaur, MD1, Shantanu Solanki, MD2, Raja Chandra Chakinala, MD3, Umair Iqbal, MD4, Abhishek Bhurwal, MD5, Zubair Khan, MD6, Harshil Shah, MD2, Khwaja S. Haq, MD7, Azam Burney, MD7, Muhammad Ali Khan, MD8, Kajali Mishra, MD1, Neil Patel, MD, MPH9, Faiza Bhatti, MD1
1Henry Ford Health System, Detroit, MI; 2Guthrie Robert Packer Hospital, Sayre, PA; 3New York Medical College Westchester Medical Center, Valhalla, NY; 4Geisinger Medical Center, Danville, PA; 5Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ; 6University of Toledo Medical Center, Toledo, OH; 7Kingsbrook Jewish Medical Center, Woodbury, NY; 8University of Alabama at Birmingham, Birmingham, AL; 9The Wright Center, Scranton, PA
Introduction: Inflammatory bowel disease is associated with increased risk of mesenteric ischemia, likely due to factors such as vascular atherosclerosis caused by long-term inflammation, vasculitis, coagulation abnormalities, and abnormal lipid metabolism. Limited data exists for hospitalizations associated with acute vascular insufficiency of the intestines (AVII) in patients with Crohn’s disease.
Methods: We analyzed the National Inpatient Sample (NIS) database for the years 2005-2011 to identify hospitalizations with Crohn’s disease (ICD-9 CM code 555.0, 555.1, 555.2, and 555.9). Hospitalizations complicated by AVII (ICD-9 CM code 557.0) in this cohort were then identified. NIS is the largest all-payer inpatient care database in the United States, containing data on more than seven million hospital stays each year. Its large sample size is ideal for developing national and regional estimates and enables analyses of rare conditions, uncommon treatments, and special populations. Temporal trends of AVII in this cohort, patient demographics, comorbidity measures, and outcomes during the study period were determined using Cochran-Armitage trend test.
Results: Between 2005 and 2011, hospitalization with CD increased from 56,739 to 65,281 (p-trend< 0.0001, figure 1A). The proportion of hospitalizations complicated by AVII increased from 0.14% in 2005 to 0.28% in 2011 (p-trend< 0.0001, figure 1B). AVII was more common in women (57.9%) (p-trend=0.0007, Figure 1C) and in Caucasians (64.7%). All-cause inpatient mortality increased from 6.3% to 7.6% (p=0.001, figure 1D). Analysis of the Agency for Healthcare Research and Quality (AHRQ) comorbidity measures revealed that hypertension, renal failure and psychiatric disorders were some of the most commonly associated comorbidities (figure 2).
Discussion: A significant increase in the number of hospitalizations for CD complicated by AVII was seen during the study period. Caucasians and women were more commonly affected than other groups. There was also an increase in the in-hospital mortality associated with these hospitalizations. Although hypertension, renal failure and psychiatric disorders were more commonly associated with AVII in Crohn's disease hospitalizations, there were several other comorbidities including diabetes mellitus, obesity and chronic pulmonary disease that showed increasing trends. Further studies are needed to identify predictors of these trends and factors responsible for such outcomes to better elucidate and perhaps support our findings.
Citation: Khwaja F. Haq, MD; Randeep Kaur, MD; Shantanu Solanki, MD; Raja Chandra Chakinala, MD; Umair Iqbal, MD; Abhishek Bhurwal, MD; Zubair Khan, MD; Harshil Shah, MD; Khwaja S. Haq, MD; Azam Burney, MD; Muhammad Ali Khan, MD; Kajali Mishra, MD; Neil Patel, MD, MPH; Faiza Bhatti, MD. P1370 - ACUTE VASCULAR INSUFFICIENCY OF THE INTESTINES IN CROHN'S DISEASE: INSIGHTS FROM THE HEALTHCARE UTILIZATION PROJECT. Program No. P1370. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.