Ihekweazu Faith D, Dongarwar Deepa, Salihu Hamisu M, Kellermayer Richard
Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 77030, USA.
Baylor College of Medicine Center of Excellence in Health Equity, Training and Research, Houston, TX 77021, USA.
Int J MCH AIDS. 2022;11(1):e522. doi: 10.21106/ijma.522. Epub 2022 Mar 6.
Therapeutic options for pediatric inflammatory bowel disease (PIBD) have dramatically changed over the last 20 years. However, the impact of modern medical management on PIBD outcomes remains unclear. We aimed to fill this gap in the literature by using a large, validated, national database, to study the change in hospitalization rates, surgical rates, and postoperative complications in PIBD over the last decade.
The National Inpatient Sample (NIS) Database and ICD-9-CM codes were utilized to identify inpatient admissions with a primary or secondary diagnosis of pediatric Crohn's disease (CD) or ulcerative colitis (UC) from 2002-2015. Trends in hospitalizations, comorbidities (including malnutrition and weight loss), surgical procedures, and postoperative complications were examined using joinpoint regression analysis, a statistical modeling approach to evaluate the extent to which the rate of a condition changes over time.
There were 119,282 admissions for PIBD during the study period. The annual incidence of hospitalization increased significantly over time for both CD (average annual percent change [AAPC] 6.0%) and UC (AAPC 7.2%). The rate of intestinal resection decreased in CD patients (AAPC -6.4%) while postoperative complications remained unchanged. However, comorbidities increased significantly in CD patients (AAPC 6.8%). For pediatric UC patients, postoperative complications (AAPC 6.7%), and comorbidities (AAPC 10.2%) increased significantly over time while intestinal resection rates remained stable. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC.
Annual incidence of hospitalization and comorbidities continue to increase in PIBD. Intestinal resection rate in pediatric CD has decreased over time, but not in pediatric UC. Our findings emphasize the critical need for prevention and novel therapeutic options for this vulnerable patient population.
在过去20年中，儿童炎症性肠病（PIBD）的治疗选择发生了巨大变化。然而，现代医学管理对PIBD治疗结果的影响仍不明确。我们旨在通过使用一个大型、经过验证的全国性数据库来填补文献中的这一空白，以研究过去十年中PIBD的住院率、手术率和术后并发症的变化。
利用国家住院患者样本（NIS）数据库和国际疾病分类第九版临床修订本（ICD-9-CM）编码，识别2002年至2015年期间原发性或继发性诊断为儿童克罗恩病（CD）或溃疡性结肠炎（UC）的住院患者。使用连接点回归分析来研究住院率、合并症（包括营养不良和体重减轻）、手术程序和术后并发症的趋势，连接点回归分析是一种统计建模方法，用于评估一种疾病的发生率随时间变化的程度。
在研究期间，有119282例PIBD住院患者。CD（年均变化百分比[AAPC]为6.0%）和UC（AAPC为7.2%）的住院年发病率均随时间显著增加。CD患者的肠切除术率下降（AAPC为-6.4%），而术后并发症保持不变。然而，CD患者的合并症显著增加（AAPC为6.8%）。对于儿童UC患者，术后并发症（AAPC为6.7%）和合并症（AAPC为10.2%）随时间显著增加，而肠切除术率保持稳定。儿童CD的肠切除术率随时间下降，但儿童UC没有。
PIBD的住院年发病率和合并症继续增加。儿童CD的肠切除术率随时间下降，但儿童UC没有。我们的研究结果强调了针对这一脆弱患者群体进行预防和开发新治疗选择的迫切需求。
