Department of Surgery, Virginia Mason Franciscan Health, 1100 9th Ave, C6-GS, Seattle, WA, 98101, USA.
Center for Digestive Health, Virginia Mason Franciscan Health, Seattle, WA, USA.
J Gastrointest Surg. 2023 Nov;27(11):2493-2505. doi: 10.1007/s11605-023-05731-8. Epub 2023 Aug 2.
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.
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.
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.
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.
炎症性肠病（IBD）住院治疗是医疗保健利用的主要因素。我们评估了华盛顿州的 IBD 住院治疗和手术操作，以描述区域化模式。
我们使用华盛顿州综合医院摘要报告系统（CHAR）从 2008 年至 2019 年确定了一组克罗恩病（CD）或溃疡性结肠炎（UC）的住院患者。通过紧急或择期的紧急程度以及是否进行手术或内镜检查来描述住院情况。使用设施量和患者的旅行距离来确定区域化。
在 95 家医院中有 20494 例 IBD 相关住院治疗：13585 例（66.3%）为 CD，6909 例（33.7%）为 UC。紧急情况占所有 IBD 相关住院治疗的 78.2%，CD（78.3%）和 UC（77.9%）之间没有差异（p=0.54）。手术在 10.3%的紧急住院治疗中进行，内镜检查在 30.6%的紧急住院治疗中进行。72.0%的紧急住院治疗发生在 22 家医院，而 71.1%的择期住院治疗集中在 9 家医院。手术在 78.5%的择期住院治疗中进行，5 家医院进行了所有择期手术的 69%。腹腔镜手术在紧急手术中（从 17%增加到 52%，p<0.001）和择期手术中（从 18%增加到 42%，p<0.001）都有所增加从 2008 年到 2019 年。
在华盛顿州，大多数 IBD 住院治疗是紧急情况，这些紧急情况分散且通常是非手术治疗。相比之下，大多数选择性入院涉及手术，集中在少数几家高容量中心。进一步了解 IBD 住院治疗的驱动因素可能有助于优化州一级的紧急医疗和选择性手术护理。
