Colectomy and the Incidence of Postsurgical Complications Among Ulcerative Colitis Patients With Private Health Insurance in the United States

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Colectomy and the Incidence of Postsurgical Complications Among Ulcerative Colitis Patients With Private Health Insurance in the United States

Authors: Loftus Jr, V.1; Delgado, J.2; Friedman, S.3; Sandborn, J.1

Source: The American Journal of Gastroenterology, Volume 103, Number 7, July 2008 , pp. 1737-1745(9)

Publisher: Blackwell Publishing

Abstract:

PURPOSE: We sought to describe the types of colectomy, follow-up surgical/diagnostic procedures, and complications occurring within 180 days of colectomy in a population of privately insured individuals with ulcerative colitis (UC). METHODS: This was a retrospective analysis of claims data of privately insured patients (MarketScan) for the years 2001-2004. We identified a cohort of patients with UC who underwent colectomy. Colectomies were classified into four categories based on the surgery occurring on the first colectomy date: (a) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), ( subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileorectal anastomosis, © TPC with ileostomy, and (d) partial colectomy (PC). Follow-up surgical/diagnostic procedures and complications were compared across colectomy categories. RESULTS: A total of 25,586 UC patients were identified, of whom 215 patients had a colectomy and at least 180 days of pre- and postcolectomy follow-up. The colectomy distribution was: TPC-IPAA (52%), SC-ileostomy (22%), TPC-ileostomy (14%), and PC (13%). Within 180 days postcolectomy, 54% of patients had a second colectomy-related surgery (including unplanned surgeries in 15.3%), and 27% had a follow-up diagnostic procedure. Postcolectomy complications included abscesses (11.6% in the first 30 days postcolectomy, 16.3% in the day 31-180 postcolectomy period), fistulas (4.2% early, 6.0% late), and sepsis/pneumonia/bacteremia (7.9% early, 9.3% late). CONCLUSION: Postcolectomy surgical procedures and complications occur frequently after colectomy in privately insured patients with UC. (Am J Gastroenterol 2008;103:1737-1745)

Document Type: Research article

DOI: 10.1111/j.1572-0241.2008.01867.x

Affiliations: 1: Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 2: DJD Health Consulting, Inc., Wayne, Pennsylvania 3: Analytic Solutions, L.L.C., New York, New York