Colectomy subtypes, follow-up surgical procedures, postsurgical complications, and medical charges among ulcerative colitis patients with private health insurance in the United States

Inflamm Bowel Dis. 2009 Apr;15(4):566-75. doi: 10.1002/ibd.20810.

Abstract

Background: We describe colectomy subtypes, follow-up surgical and diagnostic procedures, complications, and direct medical charges occurring within 180 days of colectomy among privately insured patients with ulcerative colitis (UC).

Methods: This was a retrospective analysis of an insurance claims database for 2001-2005. We identified patients with a diagnosis of UC and no concurrent diagnosis of Crohn's disease who underwent colectomy. Colectomy types were classified as: 1) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), 2) subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileorectal anastomosis, 3) TPC with ileostomy, and 4) partial colectomy (PC). Follow-up surgical and diagnostic procedures and complications were collected. We developed estimates for UC-related charges for hospitalizations, outpatient visits, and medications for the time period 180 days before and after colectomy.

Results: A total of 55,934 UC patients were identified, of whom 540 had a colectomy and at least 180 days of pre- and postcolectomy follow-up. The colectomy distribution was: TPC-IPAA, 44%; SC-ileostomy, 22%; TPC-ileostomy, 17%; and PC, 17%. Within 180 days after colectomy, 54% of patients had a second colectomy-related surgery, and 27% had a follow-up diagnostic procedure. Complications following colectomy for UC included: abscesses (11.5% early / 14.6% late), sepsis/pneumonia/bacteremia (9.3% early / 10.0% late), and fistulas (3.9% early / 8.3% late). The mean UC-related direct medical charge for the 180 days following and including initial colectomy was $90,445.

Conclusions: In this retrospective study of privately insured UC patients, we observed frequent follow-up surgical/diagnostic procedures, identified several complications postcolectomy, and estimated substantial charges 6 months pre- and postcolectomy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Colectomy / economics
  • Colectomy / statistics & numerical data*
  • Colitis, Ulcerative* / economics
  • Colitis, Ulcerative* / epidemiology
  • Colitis, Ulcerative* / surgery
  • Colonic Pouches / economics
  • Colonic Pouches / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Health Expenditures / statistics & numerical data
  • Hospital Costs / statistics & numerical data
  • Humans
  • Ileostomy / economics
  • Ileostomy / statistics & numerical data
  • Insurance, Health / statistics & numerical data*
  • Male
  • Middle Aged
  • Morbidity
  • Ostomy / economics
  • Ostomy / statistics & numerical data
  • Postoperative Complications / economics*
  • Postoperative Complications / epidemiology*
  • United States / epidemiology