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papers

Postoperative health-care utilization in Crohn’s disease: the impact of specialist care

Published: July 31, 2012
Category: Papers
Authors: Li Q, Nguyen GC, Saibil F, Steinhart AH, Tinmouth JM
Country: Canada
Language: null
Type: Care Management
Setting: Academic

Am J Gastroenterol 107:1522-1529.

Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, ON, Canad

OBJECTIVES: Crohn’s disease (CD) patients frequently require surgery. We sought to characterize postoperative health-care utilization and its impact on outcomes.

METHODS: We assembled a population-based cohort of CD patients who underwent first surgery in Ontario, Canada, between 1996 and 2009. We compared intra-individual preoperative and postoperative health-care utilization and characterized utilization of early postoperative gastrointestinal care (EPGIC) and its impact on health outcomes.

RESULTS: For the 2,943 CD patients who underwent surgery, the 5-year risk of recurrent surgery was 26%. In the 5th postoperative year, the average annual number of inflammatory bowel disease (IBD)-related clinic visits, emergency department visits, endoscopy procedures, radiological procedures, and hospitalizations decreased by 62, 62, 82, 78, and 89% compared with prior to surgery. Regional utilization of EPGIC varied between 18 and 62% and correlated with the number of gastroenterologists within a regional local health integration network (ρ=0.71; P=0.006). EPGIC was associated with reduced risk of late postoperative CD-related hospitalizations (at least 1 year after surgery; adjusted incidence ratio (IRR), 0.82; 95% confidence interval (CI): 0.72-0.94). Other predictors of late hospitalizations included having an emergency department visit within 6 months (adjusted IRR, 2.60; 95% CI: 2.21-3.05), lower income, and higher comorbidity. Individuals residing in regions with high aggregate EPGIC utilization experienced lower rates of hospitalization compared with those in regions with low utilization (adjusted IRR, 0.83; 95% CI: 0.70-0.95).

CONCLUSIONS: IBD-related health-care utilization decreased significantly up to 5 years following surgery. EPGIC may reduce late CD-related hospitalizations following surgery.

PMID: 22850430

Resource Utilization,Co-morbidity,High Risk,High-Impact Chronic Conditions,Canada,Adult,Aged,Cohort Studies,Crohn Disease/surgery,Gastroenterology/statistics & numerical data,Income,Inflammatory Bowel Diseases/therapy,Middle Aged,Multivariate Analysis,Odds Ratio,Office Visits/statistics & numerical data,Ontario/epidemiology,Preoperative Period,Reoperation/statistics & numerical data,Reoperation/utilization,Risk Assessment,Risk Factors,Time Factors,Treatment Outcome

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