CINTESIS-Center for Health Technology and Services Research, Porto, Portugal.
Grupo de Estudo da Doença Inflamatória Intestinal (GEDII), Porto, Portugal.
Clin Transl Gastroenterol. 2020 Sep;11(9):e00227. doi: 10.14309/ctg.0000000000000227.
Despite the recent emergence of expensive biologic therapies, hospitalization and surgery remain important contributors for the overall costs of inflammatory bowel disease (IBD). In this study, we aimed to describe the burden of reoperations in patients with IBD by evaluating reoperation rates, charges, and risk factors over 16 years.
We performed a retrospective analysis of all hospital discharges, with focus on reoperations and with a primary diagnosis of IBD, in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System's national registry. We collected data on patient, clinical, and healthcare charges. We used multivariate regressions to estimate the risk factors of IBD-related reoperations.
We found that 5% of IBD-related hospitalizations were related to reoperations. The number of reoperations per year increased by approximately 200%. However, when corrected by the prevalence of the disease, IBD reoperation rates decreased. Mean IBD-related charges per hospitalization were 7,780 &OV0556; in 2000 and 10,592 &OV0556; in 2015, with total charges reaching 6.7 million euros by the end of the study. Risk factors for reoperation include urgent hospitalization, in patients with ulcerative colitis (odds ratio 1.94, 95% confidence interval 1.19-3.17, P = 0.008), and colic disease, in patients with Crohn's disease (odds ratio 1.57, 95% confidence interval 1.06-2.34, P = 0.025).
To obtain an accurate scenario of reoperations among patients with IBD, it is mandatory to adjust the number of reoperations to the prevalence of the disease. Reoperation and its risk factors should be closely monitored to decrease the burden of IBD to the healthcare system.
尽管最近出现了昂贵的生物治疗药物，但住院治疗和手术仍然是炎症性肠病（IBD）总体费用的重要组成部分。在这项研究中，我们旨在通过评估 16 年来的再手术率、费用和危险因素，描述 IBD 患者的再手术负担。
我们对 2000 年至 2015 年间葡萄牙大陆公立医院的所有住院患者进行了回顾性分析，重点是再手术，并将 IBD 作为主要诊断。我们收集了患者、临床和医疗费用的数据。我们使用多元回归来估计与 IBD 相关的再手术的危险因素。
我们发现，5%的 IBD 相关住院治疗与再手术有关。每年的再手术数量增加了约 200%。然而，当按疾病的流行率校正时，IBD 再手术率下降了。2000 年每例 IBD 相关住院费用为 7780 欧元，2015 年为 10592 欧元，研究结束时总费用达到 670 万欧元。再手术的危险因素包括溃疡性结肠炎患者的紧急住院（优势比 1.94，95%置信区间 1.19-3.17，P = 0.008）和克罗恩病患者的绞痛性疾病（优势比 1.57，95%置信区间 1.06-2.34，P = 0.025）。
为了准确了解 IBD 患者的再手术情况，必须根据疾病的流行率调整再手术的数量。应密切监测再手术及其危险因素，以降低 IBD 给医疗系统带来的负担。
