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PTU-056 Outcomes of Emergency Admissions with Crohn’s Disease in Adults in England Between 2004 and 2014
  1. JG Rees1,
  2. J Mytton2,
  3. F Evison2,
  4. P Patel2,
  5. N Trudgill1
  1. 1Gastroenterology, Sandwell General Hospital
  2. 2Informatics, Queen Elizabeth Hospital, Birmingham, UK

Abstract

Introduction Between 2006 and 2010, the UK national audit of adult inflammatory bowel disease admissions revealed a small but non-significant fall in mortality in Crohn’s disease (CD) from 1.3 to 0.8%, an increase in the rate of prescription of anti-TNF therapy on admission from 3.9 to 8% and a fall in surgery from 23 to 18%.

Methods Using Hospital Episode Statistics, patients aged between 18 and 60 years coded with a first emergency admission with CD were identified. The influence of demographic factors, comorbidity and infused anti-TNF therapy on mortality, surgery and emergency readmissions was examined using multivariate logistic regression.

Results Between 2004 and 2014, 24,830 patients (55% female, mean age of 35 (IQR 25–44)). Mortality was 0.22% at 30 days, 0.29% in hospital and 0.81% within 1 year. During admission, 19.2% of patients underwent surgery (median time to surgery 2 days (IQR 1–6)) and 1.9% received infused anti-TNF therapy. Surgery during admission rose from 16.1 to 22.9% (OR 1.52 (95% CI 1.32–1.75) p < 0.001) between 2004 and 2014, and infused anti-TNF therapy rose from 1.8 to 2.8% between 2006 and 2014. In-hospital and 1 year mortality fell from 0.51 and 1.03% in 2004 to 0.10 and 0.57% in 2013 (0.18 (95% CI 0.04–0.77) p = 0.021 and 0.46 (0.23–0.91) p = 0.026 respectively). Patients aged 35–60 had a higher 30 day (3.99 (1.97–8.05) p < 0.001) and 1 year mortality (4.57 (3.14–6.65) p < 0.001) than those aged 18–34. Increasing comorbidity (15.38 (7.33–32.23) p < 0.001) and deprivation (3.14 (1.06–9.31) p = 0.039) was associated with a higher 30 day and 1 year mortality, but not gender. Females were less likely to have surgery during their admission (0.71 (0.67–0.76) p < 0.001) or within 1 year (0.82 (0.77–0.97) p < 0.001) and surgery within 1 year was more common in younger (35–60 years 0.87 (0.81–0.93) p < 0.001) and non-white patients (1.18 (1.08–1.28) p < 0.001). Anti-TNF therapy during admission was associated with less surgery immediately (0.39 (0.28–0.54) p < 0.001) and within 1 year (0.55 (0.41–0.73) p < 0.001). Emergency readmissions within 30 days were associated with male gender (females 0.74 (0.55–0.98) p 0.039), younger age (35–60 years 0.85 (0.79–0.91) p < 0.001), non-white ethnicity (1.25 (1.13–1.38) p < 0.001) and not having anti-TNF therapy during admission (0.74 (0.55–0.98) p0.039).

Conclusion For patients with a first emergency admission for CD, in-hospital and 1 year mortality fell considerably over the study period. Surgery and anti-TNF therapy during admission has increased between 2004 and 2014. Surgery during admission was associated with men and at 1 year with men, younger age and non-white ethnicity.

Disclosure of Interest J. Rees Grant/research support from: £10,000 from Merck Sharp and Dome (MSD) to contribute to costs of HES access, J. Mytton: None Declared, F. Evison: None Declared, P. Patel: None Declared, N. Trudgill: None Declared

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