C0399 - Venous Thromboembolism Rates Among Patients Hospitalized for Inflammatory Bowel Disease Exacerbation: A Time Trend Analysis of the National Inpatient Sample

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

LS

Laura Sahyoun Rotundo, MD

Yale New Haven Hospital
New Haven, CT

Laura Sahyoun Rotundo, MD¹, Dushyant S. Dahiya, MD², Chin-I Cheng, PhD³, Keith Sultan, MD⁴
¹Yale New Haven Hospital, New Haven, CT; ²Central Michigan University College of Medicine, Saginaw, MI; ³Central Michigan University, Mount Pleasant, MI; ⁴Long Island Jewish Medical Center, North Shore University Hospital, Long Island, NY

Introduction: Inflammatory bowel disease (IBD) flare increases risk of venous thromboembolism (VTE) events, especially during hospitalization. Guidelines, support the use of VTE prophylaxis for these patients, but it is unclear if this has impacted rates of VTE. Our goal was to assess time trends of VTE rates among IBD admissions.

Methods: Patients hospitalized from 2007 to 2019 were identified in the National Inpatient Sample (NIS) by International Classification of Diseases (ICD), 9th and 10th Revision codes. Patients with IBD flare were selected by either a) a primary diagnosis of Crohn’s disease (CD) or Ulcerative colitis (UC) or b) a secondary diagnosis of CD or UC with a primary diagnosis of a gastrointestinal manifestations of IBD: abdominal pain, anemia, malnutrition, or dehydration. Hospitalizations for VTE were identified by those with a primary or secondary diagnosis of VTE. Patients with chronic thrombosis or prior VTE were excluded. Incidence of VTE was assessed by disease type (CD vs. UC) and by racial/ethnic identification: white, black, Hispanic, Asian or Pacific Islander, Native American, other. Cochran-Armitage trend tests were used for binary variables while trends for variables with reported mean averages used linear regression. The Rao-Scott design-adjusted chi-square test was used to evaluate the association between binary variables and the diagnosis of IBD in patients with VTE.

Results: 131,541 weighted cases were admitted for an IBD flare complicated by VTE; 73,530 had CD and 58,011 had UC, Table 1. VTE prevalence was higher among patients with UC compared to CD, 42.6 vs. 30.7 per 1,000 hospitalizations, respectively. Over the study period, the rates of VTE in IBD hospitalizations increased, from 3.58% to 4.62% for UC (p< 0.0001) and from 2.22% to 3.66% for CD (p< 0.0001), Figure 1a. Black patients with IBD were found to be at higher risk of VTE (aOR 1.075, p=0.002), while Hispanic and Asian / Pacific Islanders had lower risk for developing VTE when compared to Whites (aOR 0.873 and 0.658, respectively; p< 0.0001). Aside from Hispanic and Native American UC patients, all races and ethnicities had increasing trends of VTE during the study period, Figure 1b, 1c.

Discussion: IBD admissions complicated by VTE have significantly increased. Though increasing awareness of VTE with IBD flare may have resulted in additional diagnoses, the study findings suggest that current VTE prophylaxis, or utilization of VTE prophylaxis, may be inadequate for those hospitalized for IBD flare.

Figure: Figure 1. VTE rates as % of total IBD hospitalizations per year.

Variable		Crohn's Disease (n=73,530)	Ulcerative Colitis (n=58,011)
Age in years [Mean(SD)]		56 (0.16)	60 (0.19)
Sex
	Male	43.7%	50.3%
	Female	56.3%	49.7%
Race*
	White	81.1%	79.6%
	Black	12.3%	10.4%
	Hispanic	3.8%	6.1%
	Asian / Pacific Islander	0.5%	1.1%
	Native American	0.4%	0.4%
	Other	1.9%	2.5%
Insurance Type
	Medicare	48.5%	48.9%
	Medicaid	12.5%	8.8%
	Private Insurance	32.7%	36.4%
	Self-Pay	3.2%	2.8%
	Other	3.1%	3.1%
Hospital Bed Size
	Small	13.8%	13.5%
	Medium	25.1%	24.8%
	Large	61.1%	61.7%
Hospital Location/ Type
	Rural	7.2%	6.1%
	Urban Nonteaching	28.0%	28.9%
	Urban Teaching	64.8%	65.0%
Charlson Comorbidity Index
	CCI = 0	36.4%	35.5%
	CCI = 1	21.8%	21.3%
	CCI = 2	15.5%	14.7%
	CCI ≥ 3	26.3%	28.6%
Hospitalization Cost		$95,500	$110,473
Length of Stay (in mean days)		10.39	11.25
Death (per 1,000 hospitalizations)		41.8	61.4

Table: Table 1. Patient Demographics and Hospital Characteristics of IBD Patients Admitted with VTE
*There were some charts where race was documented in NIS as unknown.

Disclosures:

Laura Sahyoun Rotundo indicated no relevant financial relationships.

Dushyant Dahiya indicated no relevant financial relationships.

Chin-I Cheng indicated no relevant financial relationships.

Keith Sultan indicated no relevant financial relationships.

Laura Sahyoun Rotundo, MD¹, Dushyant S. Dahiya, MD², Chin-I Cheng, PhD³, Keith Sultan, MD⁴. C0399 - Venous Thromboembolism Rates Among Patients Hospitalized for Inflammatory Bowel Disease Exacerbation: A Time Trend Analysis of the National Inpatient Sample, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.