IMPACT OF COLONOSCOPY ON OUTCOMES FOR ADMISSIONS IN GERIATRIC PATIENTS WITH ULCERATIVE COLITIS

Background: Evidence regarding healthcare utilization and outcomes in inflammatory bowel disease (IBD) hospitalizations with coexisting cirrhosis is scant.As a result, we used the National Inpatient Sample database to evaluate the impact of cirrhosis on hospitalization characteristics and outcomes in patients with Crohn's disease (CD) and ulcerative colitis (UC).Methods: We identified all admissions that listed IBD by ICD-10-CM code (K50.X for CD and K51.X for UC) in the National Inpatient Sample for the year 2016.Attributes of admissions with cirrhosis (K74) and IBD were compared to non-cirrhosis IBD admissions.Statistical analysis was performed using SAS 9.3, utilizing sample weights provided in the NIS dataset.Chi-square test and bivariate linear regression were used to compare categorical and continuous variables between the groups.Multivariate logistic and linear regression was used to analyze mortality, length of stay and total hospital charges.Results: A total of 319,890 all-cause admissions for patients with IBD were identified, including 8,045 with a concomitant diagnosis of cirrhosis.Patients with IBD and cirrhosis were more likely to be male, had similar Elixhauser comorbidity index (ECI), and were less likely to undergo alimentary surgery as compared to IBD patients without cirrhosis.In a multivariate model, after adjusting for ECI, age, alimentary surgery during the admission and hospital type (teaching, urban non-teaching or rural), the presence of cirrhosis was associated with higher inpatient mortality [Odds Ratio-1.49(95% CI 1.12-1.96)]and increased cost of admission [mean difference $8,467 (95% CI 1,180-16,115), p=0.023].No significant difference was noted in length of stay (LOS) [difference 0.13 days (95% CI -0.23-0.49),p=0.492] among these groups.Conclusions: The epidemiology of IBD is evolving given the rising incidence of non-alcoholic fatty liver disease, alcoholic liver disease and longer life expectancy in the era of biologics.We demonstrate that the presence of cirrhosis has a negative impact on outcomes for hospitalized patients with IBD as reflected by increased in-hospital mortality and higher cost of admission.Further prospective multicenter studies are needed to evaluate predictors of mortality and ways to mitigate this complication in patients with cirrhosis and IBD.