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Association of Inflammatory Bowel Disease and Urolithiasis in Hospitalized Pediatric Patients
Christopher M Stark1, Gregory H Gorman, Cade M Nylund
1*Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland; and †Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Insights
Pediatric patients with inflammatory bowel disease (IBD) face a higher risk of urolithiasis. Those with ulcerative colitis experienced longer hospital stays and increased costs, while IBD patients underwent fewer procedures.
Area of Science:
- Pediatric Nephrology
- Pediatric Gastroenterology
- Health Services Research
Background:
- Urolithiasis is uncommon in children, but inflammatory bowel disease (IBD) increases risk.
- The specific risk and impact of urolithiasis in pediatric IBD patients are not well-defined.
Purpose of the Study:
- To assess the association between IBD and urolithiasis in hospitalized children.
- To evaluate surgical outcomes and financial implications for pediatric urolithiasis patients with comorbid IBD.
Main Methods:
- Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database (1997-2012).
- Inclusion of nonpregnant children aged 5-20 years with urolithiasis.
- Logistic regression to determine IBD-urolithiasis association; comparison of hospital stay, costs, procedures, and complications.
Main Results:
- Urolithiasis occurred in 36,771 admissions; 230 with Crohn's disease (OR 1.99) and 102 with ulcerative colitis (OR 1.63).
- Pediatric patients with ulcerative colitis and urolithiasis had longer stays and higher costs compared to those without IBD.
- Patients with IBD (Crohn's or ulcerative colitis) had fewer urologic procedures for urolithiasis.
Conclusions:
- Pediatric urolithiasis is significantly associated with IBD.
- Ulcerative colitis in pediatric urolithiasis patients correlates with increased hospital length of stay and costs.
- IBD diagnosis in pediatric urolithiasis cases is linked to a reduction in urologic procedures.
Background:
Urolithiasis is rare in pediatric patients. All patients with inflammatory bowel disease (IBD) have an increased risk of urolithiasis, but this risk is poorly quantified in children. The objective of this study is to evaluate the association of IBD with urolithiasis, assess surgical outcomes, and analyze the financial burden for children hospitalized with urolithiasis and comorbid IBD.
Methods:
The triennial Healthcare Cost and Utilization Project Kids' Inpatient Database for years 1997 to 2012 was used to evaluate the association between urolithiasis and IBD in hospitalized, nonpregnant children ages 5 to 20 years old. Billing codes were used to define conditions. Logistic regression analysis quantified the association between IBD types and urolithiasis. Length of hospital stay, costs, procedures, and complications were compared between urolithiasis patients with and without IBD.
Results:
Among 8,828,522 hospital admissions, we identified 36,771 admissions with a primary diagnosis of urolithiasis. Of these cases, 230 were associated with Crohn's disease (odds ratios, 1.99; 95% confidence interval, 1.74-2.27) and 102 with ulcerative colitis (odds ratio, 1.63; 95% confidence interval, 1.34-1.99). Urolithiasis patients with ulcerative colitis, but not Crohn's disease, had significantly increased length of stay and costs. Patients with either IBD had a decreased number of urologic procedures.
Conclusions:
The diagnosis of urolithiasis in pediatric patients is associated with IBD, and those with ulcerative colitis have longer hospital stays and greater costs. Patients with IBD have fewer urologic procedures associated with their urolithiasis diagnosis.
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