Treatment of intra-abdominal abscesses in Crohn's disease: a nationwide analysis of patterns and outcomes of care. Dig Dis Sci 2013 Jul;58(7):2013-8
Date
02/09/2013Pubmed ID
23392744Pubmed Central ID
PMC3663922DOI
10.1007/s10620-013-2579-zScopus ID
2-s2.0-84879840276 (requires institutional sign-in at Scopus site) 24 CitationsAbstract
BACKGROUND: Abdominal abscesses are a common complication in Crohn's disease (CD). Percutaneous drainage of such abscesses has become increasingly popular and may deliver outcomes comparable to surgical treatment; however, such comparative data are limited from single-center studies. There have been no nationally representative studies comparing different treatment modalities for abdominal abscesses.
METHODS: We identified all adult CD-related non-elective hospitalizations from the Nationwide Inpatient Sample 2007 that were complicated by an intra-abdominal abscess. Treatment modality was categorized into 3 strata-medical treatment alone, percutaneous drainage, and surgery. We analyzed the nationwide patterns in the treatment and outcomes of each treatment modality and examined for patient demographic, disease, or hospital-related disparities in treatment and outcome.
RESULTS: There were an estimated 3,296 hospitalizations for abdominal abscesses in patients with CD. Approximately 39 % were treated by medical treatment alone, 29 % with percutaneous drainage, and 32 % with surgery with a significant increase in the use of percutaneous drainage since 1998 (7 %). Comorbidity burden, admission to a teaching hospital, and complicated Crohn's disease (fistulae, stricture) were associated with non-medical treatment. Use of percutaneous drainage was more common in teaching hospitals. Mean time to percutaneous drainage and surgical treatment were 4.6 and 3.3 days, respectively, and early intervention was associated with significantly shorter hospitalization.
CONCLUSIONS: We describe the nationwide pattern in the treatment of abdominal abscesses and demonstrate an increase in the use of percutaneous drainage for the treatment of this subgroup. Early treatment intervention was predictive of shorter hospitalization.
Author List
Ananthakrishnan AN, McGinley ELAuthor
Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Abdominal AbscessAdult
Crohn Disease
Databases, Factual
Drainage
Female
Hospital Costs
Humans
Laparotomy
Length of Stay
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Practice Patterns, Physicians'
Propensity Score
Treatment Outcome
United States
