Colectomy subtypes, follow-up surgical procedures postsurgical complications, and medical charges among ulcerative colitis patients with private health insurance in the United States

Edward V. Loftus, Howard S. Friedman, David J. Delgado, William J. Sandborn

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

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%; SC-ileostomy, 22%; TPC-ileostomy, 17%; and PC, 17%. Within 180 days after colectomy, 54% of patients had a second colectomy-related 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.

Original languageEnglish (US)
Pages (from-to)566-575
Number of pages10
JournalInflammatory bowel diseases
Volume15
Issue number4
DOIs
StatePublished - Jul 17 2009

Keywords

  • Colectomy
  • Complications
  • Direct medical charges
  • Ileal pouch-anal anastomosis
  • Morbidity
  • Ulcerative colitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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