Colectomy subtypes, follow-up surgical procedures, postsurgical complications, and medical charges among ulcerative colitis patients with private health insurance in the United States
✍ Scribed by Edward V. Loftus Jr.; Howard S. Friedman; David J. Delgado; William J. Sandborn
- Publisher
- John Wiley and Sons
- Year
- 2009
- Tongue
- English
- Weight
- 227 KB
- Volume
- 15
- Category
- Article
- ISSN
- 1078-0998
No coin nor oath required. For personal study only.
✦ Synopsis
Background:
We describe colectomy subtypes, follow-up surgical and diagnostic procedures, complications, and direct medical charges occurring within 180 days of colectomy among privately insured patients with ulcerative colitis (UC).
Methods:
This was a retrospective analysis of an insurance claims database for 2001-2005. We identified patients with a diagnosis of UC and no concurrent diagnosis of Crohn's disease who underwent colectomy. Colectomy types were classified as: 1) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA), 2) subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileorectal anastomosis, 3) TPC with ileostomy, and 4) partial colectomy (PC). Follow-up surgical and diagnostic procedures and complications were collected. We developed estimates for UC-related charges for hospitalizations, outpatient visits, and medications for the time period 180 days before and after colectomy.
Results: A total of 55,934 UC patients were identified, of whom 540 had a colectomy and at least 180 days of pre-and postcolectomy follow-up. The colectomy distribution was: TPC-IPAA, 44%; SCileostomy, 22%; TPC-ileostomy, 17%; and PC, 17%. Within 180 days after colectomy, 54% of patients had a second colectomyrelated surgery, and 27% had a follow-up diagnostic procedure. Complications following colectomy for UC included: abscesses (11.5% early / 14.6% late), sepsis/pneumonia/bacteremia (9.3% early / 10.0% late), and fistulas (3.9% early / 8.3% late). The mean UC-related direct medical charge for the 180 days following and including initial colectomy was $90,445.
Conclusions:
In this retrospective study of privately insured UC patients, we observed frequent follow-up surgical/diagnostic procedures, identified several complications postcolectomy, and estimated substantial charges 6 months pre-and postcolectomy.