Early Sigmoidoscopy or Colonoscopy Is Associated With Improved Hospital Outcomes in Ulcerative Colitis-Related Hospitalization

Kenneth Obi; Alice Hinton; Lindsay Sobotka; Razvan Arsenescu; Somashekar G Krishna; Edward J Levine; Cheng Zhang

doi:10.1038/ctg.2016.61

Early Sigmoidoscopy or Colonoscopy Is Associated With Improved Hospital Outcomes in Ulcerative Colitis-Related Hospitalization

Clin Transl Gastroenterol. 2016 Dec 1;7(12):e203. doi: 10.1038/ctg.2016.61.

Authors

Kenneth Obi¹, Alice Hinton², Lindsay Sobotka³, Razvan Arsenescu⁴, Somashekar G Krishna¹, Edward J Levine¹, Cheng Zhang¹

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
² Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
³ Department of Medicine, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA.
⁴ Department of Gastroenterology, Morristown Medical Center, Morristown, New Jersey, USA.

Abstract

Objectives: Performing a sigmoidoscopy or colonoscopy is recommended for assessment of disease activity, excluding infection, and guiding medical treatment during ulcerative colitis (UC)-related hospitalizations. However, it is unknown whether the timing of endoscopy impacts clinical outcomes. The objective of our study was to determine the impact of timing of endoscopy on hospital outcomes in patients with UC-related hospitalizations.

Methods: This is a cross-sectional study using data from the Nationwide Inpatient Sample database (2006-2013). Adult inpatients (≥19 years) with UC-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification codes (ICD-9-CM). Hospital outcomes stratified by disease severity were compared between patients receiving early (<3 days after admission) and delayed endoscopies (between 3 and 7 days after admission). The primary clinical outcomes included mortality, frequency of large intestine surgery, length of stay (LOS), and hospital cost. Results were analyzed using univariate and multivariate analyses.

Results: Of a total of 84,359 patients with UC-related hospitalizations, 67.2% (56,657) underwent an early endoscopy and 32.8% (27,702) underwent a delayed endoscopy. Delayed endoscopy was associated with higher mortality (adjusted odds ratio: 1.76 (95% confidence interval (CI): 1.08, 2.88)), prolonged LOS (adjusted coefficient: 2.69 (95% CI: 2.61, 2.77)), and higher hospital cost (adjusted coefficient: $3,394 (95% CI: 3,234, 3,554)). In UC patients with intermediate disease severity, delayed endoscopy was associated with an increased frequency of large intestine surgery (adjusted odds ratio: 1.60 (95% CI: 1.01, 2.53)).

Conclusions: In UC-related hospitalizations, the timing of endoscopic procedures impacts outcomes. Early endoscopy is associated with decreased mortality and better health-care utilization (LOS and hospital cost) compared with delayed endoscopy. In UC patients with intermediate disease severity, early endoscopy is also associated with a decreased frequency of large intestine surgery.