P1581 - Outcomes and Healthcare Burden of Elective Small Bowel Resection for Crohn’s Disease in Patients With Severe Protein-Calorie Malnutrition

Miguel Salazar, MD, CNSC¹, Ji Seok Park, MD, MPH, CNSC¹, Mohamed Tausif Siddiqui, MD¹, Gianina Flocco, MD², Douglas L. Seidner, MD, CNSC, FACG¹, Donald F. Kirby, MD, CNSC, CPNS, FACG^1
1Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic Foundation, Shaker Heights, OH

Introduction: Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) that predisposes patients to severe protein caloric malnutrition (PCM), which itself is an independent risk factor for adverse post-operative outcomes and affects up to 70% of the IBD population. We aimed to compare outcomes and healthcare burden of patients undergoing small bowel resection (SBR) for CD with and without severe PCM.

Methods: A retrospective cohort study of the 2016-2017 National Inpatient Sample database was performed, using ICD10 codes to identify patients discharged that underwent elective SBR for CD and those with a secondary diagnosis of severe PCM. Primary endpoint was in-hospital mortality. Secondary endpoints were LOS, hospital related charges, inpatient complications and advanced therapy. Multivariate regression analysis models to adjust for patient and hospital characteristics and were performed for both primary and secondary outcomes.

Results: We found 9,885 admitted for SBR with CD, of which 25.6% (2,530) had a diagnosis of severe PCM. These patients were more likely to be admitted on weekends (11.6% vs 15.0%;P< 0.01), belong to the lower income bracket (19.6% vs 24.8%;P< 0.01), have Medicaid (10.3% vs 17.9%;P< 0.01), live in the western US (16.1% vs 19.9%;P=0.03), be admitted to large hospitals (55.5% vs 64.0%;P< 0.01), have iron deficiency (9.4% vs 18.0%;P< 0.01), upper GI bleeding (0.1% vs 0.4%;P< 0.01), hyponatremia (6.9% vs 22.9%;P< 0.01), hypokalemia (15.0% vs 29.5%;P< 0.01), hypophosphatemia (4.7% vs 11.3%;P< 0.01), volume depletion (8.1% vs 20.4%;P< 0.01), require blood transfusions (10.8% vs 20.4%;P< 0.01) and parenteral nutrition (3.1% vs 21.7%;P< 0.01). On multivariate analysis we found increased in-hospital mortality [aOR 2.28;(P< 0.01)], prolonged LOS [11.45;(P< 0.01)], health care burden including total charges [$126,771;(P< 0.01)] and costs [$30,689;(P< 0.01)]. We also found higher in-hospital complications including endotracheal intubation [aOR 3.50;(P< 0.01)], prolonged ( >96 hours) mechanical ventilation [aOR 5.90;(P< 0.01)], higher acute kidney injury [aOR 2.96;(P< 0.01)], sepsis [aOR 3.41;(P< 0.01)], respiratory failure [aOR 3.60;(P< 0.01)] and VTE [aOR 5.06;(P< 0.01)].

Discussion: Severe PCM increases in-hospital mortality, health care burden and LOS. Overall presents with worse post-operative outcomes after elective SBR in CD. This highlights the importance of preoperative nutrition optimization for patients with CD and severe PCM, who are undergoing elective SBR.



Disclosures:


Miguel Salazar, MD, CNSC¹, Ji Seok Park, MD, MPH, CNSC¹, Mohamed Tausif Siddiqui, MD¹, Gianina Flocco, MD², Douglas L. Seidner, MD, CNSC, FACG¹, Donald F. Kirby, MD, CNSC, CPNS, FACG¹. P1581 - Outcomes and Healthcare Burden of Elective Small Bowel Resection for Crohn’s Disease in Patients With Severe Protein-Calorie Malnutrition, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.