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Trends and Attributable Costs of Anorectal Involvement in Pediatric Crohn's Disease
Colin G DeLong1, Afif N Kulaylat1, Audrey S Kulaylat1
1Division of Pediatric Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania.
Insights
Pediatric Crohn's disease with anorectal involvement is increasing and associated with longer hospital stays and higher costs. This highlights a growing healthcare burden for pediatric inflammatory bowel disease patients.
Area of Science:
- Gastroenterology
- Pediatric Inflammatory Bowel Disease
- Health Services Research
Background:
- Pediatric Crohn's disease (CD) with anorectal involvement is not well-characterized.
- Understanding trends and healthcare utilization for this subgroup is crucial.
Purpose of the Study:
- To describe trends in pediatric CD with anorectal involvement.
- To assess the influence of anorectal involvement on healthcare utilization.
Main Methods:
- Analysis of the Kid's Inpatient Database (2003-2012) for patients (<21 years) with CD.
- Stratification by anorectal involvement using ICD-9 codes and procedure codes.
- Comparison of patient characteristics, length of stay (LOS), and costs using propensity score matching.
Main Results:
- 6.6% of pediatric CD patients (26,029 total) had anorectal involvement.
- Anorectal involvement increased over time (OR 1.03).
- Associated with longer LOS (0.5 days) and higher costs (~$1600) after matching.
Conclusions:
- Increasing proportion of pediatric CD hospitalizations involve anorectal manifestations.
- Anorectal involvement significantly increases hospitalization duration and healthcare costs.
- Further research needed to elucidate the etiology of these trends.
Background:
Pediatric Crohn's disease (CD) with anorectal involvement has not been well characterized. We sought to describe trends in the prevalence of pediatric CD with anorectal involvement and its influence on health-care utilization.
Materials And Methods:
Patients (<21 y of age) with an International Classification of Diseases, Ninth Revision diagnosis of CD (555.X) were identified in the Kid's Inpatient Database (2003, 2006, 2009, 2012) and stratified by anorectal involvement based on the International Classification of Diseases, Ninth Revision diagnosis and procedural codes. Patient characteristics and resource utilization (length of stay [LOS] and costs) were compared between CD patients with and without anorectal involvement using univariate and multivariable analyses. Propensity score matching was used to estimate attributable LOS and costs.
Results:
There were 26,029 patients with CD identified in the study interval. Of these, 1706 (6.6%) had anorectal involvement. Those with anorectal disease were younger (age 16 versus 17 y old), more likely to be male (59.4% versus 49.9%) and black or Hispanic (24.7% versus 18.2%), and were more commonly treated in urban teaching hospitals compared with rural or nonteaching hospitals (83.2% versus 70.9%) (P < 0.001 for all). The proportion of patients with anorectal involvement increased over time (odds ratio 1.03, 95% confidence interval 1.02-1.05). After propensity score matching, attributable LOS and costs were 0.5 d and approximately $1600, respectively.
Conclusions:
There has been an increase in the proportion of pediatric CD hospitalizations with anorectal manifestations. This pattern of disease is associated with longer hospitalization and higher costs compared with CD alone. Further research is required to understand the underlying etiology of these observed trends.