Weekend hospitalisations and post-operative complications following urgent surgery for ulcerative colitis and Crohn's disease

Abstract

Background: There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease [IBD; Crohn's disease (CD), ulcerative colitis (UC)] with frequent requirement for urgent surgery.

Aim: To determine whether a weekend effect exists for IBD care in the United States.

Methods: We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all-payer hospitalisation database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalisation were identified using the appropriate ICD-9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders.

Results: Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post-operative complications were more common following weekend than weekday hospitalisations in UC [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01-2.90]. The most common post-operative complication was post-operative infections (Weekend 30% vs. weekday 20%, P = 0.04). The most striking difference between weekend and weekday hospitalisations was noted for needing repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post-operative complication in CD was similar between weekday and weekend admissions.

Conclusion: Patients with UC hospitalised on a weekend undergoing urgent surgery within 2 days have an increased risk for post-operative complications, in particular mechanical wound complications, need for repeat laparotomy and post-operative infections.

Figure 1

Derivation of the study cohort of patients with inflammatory bowel disease undergoing urgent intestinal surgery within 2 days of hospitalization

Figure 2. Multivariate^† analysis of post-operative complications following urgent intestinal surgery for ulcerative colitis

† Adjusted for age, gender, Charlson co-morbidity index, hospital bed-size and teaching status, and zip code level income

Figure 3. Multivariate^† analysis of post-operative complications following urgent intestinal surgery for Crohn’s disease

† Adjusted for age, gender, Charlson co-morbidity index, hospital bed-size and teaching status, and zip code level income