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PWE-064 Changing nationwide patterns in uk admissions for medical therapy, surgery, lower gi endoscopy and anti-tnf infusions for inflammatory bowel disease between 2003–2013
  1. A Ahmad,
  2. A Laverty,
  3. C Alexakis,
  4. T Cowling,
  5. S Saxena,
  6. A Majeed,
  7. RCG Pollok

Abstract

Introduction In the last decade there have been profound advances in the management of inflammatory bowel disease (IBD) but their impact on hospital admissions requires evaluation. We hypothesised changes in medical treatment in the biologic era have impacted on the pattern of admissions and surgery rates.

Method We used Hospital Episode Statistics and population data from the Office for National Statistics in England between 2003–04 and 2012–13.

Results Overall age-sex standardised admission rates (both inpatient and day case) increased from 76.5 to 202.9 per 1 00 000 population and from 69.5 to 149.5 for Crohn’s disease (CD) (p<0.001) and ulcerative colitis (UC) (p<0.001) between 2003–04 and 2012–13. The proportion of elective day case activity increased from 68.9% to 89.2% (p<0.001) and from 78.5% to 88.1% (p<0.001) for CD and UC respectively. Increases were driven by a large rise in elective admissions for lower GI endoscopies and cytokine inhibitor infusions. Mean length of stay fell significantly for both elective and emergency admission. Elective lower GI endoscopy rates increased from 30.5 to 57.9 and from 14.1 to 35.7 for CD and UC respectively. Between 2006/07 and 2012/13 elective (day case) admission rates for cytokine inhibitor infusions (infliximab) increased from 11.1 to 57.2 and from 1.4 to 12.1 for CD and UC respectively. Elective major abdominal surgery rates increased from 3.4 to 4.0 (p<0.001) and from 3.4 to 3.6 (p=0.01) but emergency surgery rates remained static for CD and UC respectively.

Conclusion Overall admission rates have risen over the past decade but with a shift from emergency management towards more efficient planned elective hospital based care. Rising rates of lower GI endoscopy and anti-TNF infusions and a plateau in rates of abdominal surgery suggest a move towards medical management of IBD.

Disclosure of Interest None Declared

  • Admission rates
  • Crohn’s disease
  • Endoscopy
  • England
  • Inflammatory Bowel Disease
  • Infliximab
  • Length of hospital stay
  • NHS
  • Surgery
  • Ulcerative colitis

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