Characterizing Regionalization of Inflammatory Bowel Disease Hospitalizations and Operations in Washington State

• Published in: Journal of gastrointestinal surgery Vol. 27; no. 11; pp. 2493 - 2505
• Main Authors: Stovall, Stephanie L., Soriano, Celine R., Kaplan, Jennifer A., La Selva, Danielle, Lord, James, Moonka, Ravi, Zisman, Timothy L., Simianu, Vlad V.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2023; Springer Nature B.V
• Subjects: Codes; Colitis, Ulcerative - surgery; Crohn Disease - surgery; Crohns disease; Data dictionaries; Demography; Elective surgery; Endoscopy; Gastroenterology; Gastrointestinal surgery; Hospitalization; Humans; Inflammatory bowel disease; Inflammatory Bowel Diseases - surgery; Laparoscopy; Medicine; Medicine & Public Health; Original Article; Patients; Surgery; Washington - epidemiology; Washington; United States > US; Washington (state); Inflammatory bowel disease; Minimally invasive surgery; Emergent hospitalizations; Elective surgery
• DOI: 10.1007/s11605-023-05731-8
• ISSN: 1091-255X

Background Hospitalizations for inflammatory bowel disease (IBD) are a major contributor of healthcare utilization. We assessed IBD hospitalizations and surgical operations in Washington State to characterize regionalization patterns. Methods We identified a cohort of hospitalizations for Crohn’s disease (CD) or ulcerative colitis (UC) from 2008 to 2019 using Washington State’s Comprehensive Hospital Abstract Reporting System (CHARS). Hospitalizations were characterized by emergent or elective acuity and whether an operation or endoscopic procedure was performed. Facility volume and distance travelled by patients were used to determine regionalization. Results There were 20,494 IBD-related hospitalizations at 95 hospitals: 13,585 (66.3%) with CD and 6,909 (33.7%) with UC. Emergencies accounted for 78.2% of all IBD-related hospitalizations and did not differ between CD (78.3%) and UC (77.9%) ( p  = 0.54). Surgery was performed during 10.3% and endoscopy during 30.6% of emergent hospitalizations. 72.0% of emergent hospitalizations occurred at 22 facilities, while 71.1% of elective hospitalizations were concentrated at 9 facilities. Operations were performed during 78.5% of elective hospitalizations, and five hospitals performed 69% of all elective surgery. Laparoscopic surgery increased in both emergent (17% to 52%, p  < 0.001) and elective operations (18% to 42%, p  < 0.001) from 2008 to 2019. Conclusions In Washington State, most IBD hospitalizations were emergent, which were decentralized and typically non-operative. By contrast, most elective admissions involved surgery and were centralized at a few high-volume centers. Further understanding the drivers behind IBD hospitalizations may help optimize emergent medical and elective surgical care at a state level.