Korean J Gastroenterol.  2022 Sep;80(3):142-148. 10.4166/kjg.2022.061.

Crohn's Disease with Fistula: 10 Year Trends and Mortality in the United States

• Ali H
• Ishtiaq R
• Waqar Hanif M
• Pamarthy R
• Farooq MH
• Fahd Farooq M

• KMID: 2533317
• DOI: http://doi.org/10.4166/kjg.2022.061

Abstract

Background/aims
Crohn's disease (CD) results in significant morbidity, mortality, and healthcare burden. This study evaluated the temporal trends of CD hospitalizations with a fistula over the last decade to understand the outcomes of severe CD.
Methods
National Inpatient Sample database from 2009 to 2019 was used to identify CD hospitalizations with a fistula. The outcomes of interest included temporal trend analysis of length of stay (LOS), mean inpatient cost (MIC), and mortality.
Results
There was an increase in the total number of fistulizing CD hospitalizations from 5,386 in 2009 to 12,900 in 2019 (p<0.01). The mean age decreased from 44.9±0.6 to 41.8±0.4 years for the study period (p<0.01). Caucasians were the predominant ethnicity, followed by Africans, Hispanics, and others (p<0.001). The mean LOS for fistulizing CD hospitalizations decreased significantly from 11.57±0.09 days in 2009 to 7.20±0.05 days in 2019 (p<0.001). There was a significant decrease in inpatient mortality from 1.72% in 2009 to 0.73% in 2019 (p<0.01). The MIC did not have a significant trend. There was a decreasing trend toward partial/total colectomies, rectosigmoid, and small bowel surgeries from 2009 to 2019 (p<0.001).
Conclusions
There has been a rise in CD hospitalizations with fistulizing disease in the last decade. Despite this, the mortality and inpatient LOS have been decreasing significantly. In addition, the increase in CD hospitalizations with fistulizing disease has had no significant effect on hospital costs.

Keyword

Crohn disease; Health care costs; Inpatients; Retrospective studies; Fistula

Figure

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  Fig. 1 Trend in the number of admissions in patients with a diagnosis of fistulizing Crohn’s disease from 2009-2019 in United States hospitals based on age groups, Nationwide Inpatient Sample data 2009-2019.

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  Fig. 2 Trend in the inpatient cost and hospital stay in patients with a diagnosis of fistulizing Crohn’s disease from 2009-2019 in United States hospitals, Nationwide Inpatient Sample data 2009-2019.

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  Fig. 3 Trend in the number of admissions and mortality (%) in patients with a diagnosis of fistulizing Crohn’s disease from 2009-2019 in United States hospitals, Nationwide Inpatient Sample data 2009-2019.

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  Fig. 4 Trend in the partial, total colectomies, rectosigmoid surgeries, and small bowel surgeries (%) in patients with a diagnosis of fistulizing Crohn’s disease from 2009-2019 in United States hospitals, Nationwide Inpatient Sample data 2009-2019.

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