Abstract
Given the increase in prevalence of Inflammatory Bowel Disease (IBD) worldwide and the increase in general population life expectancy, it is expected to for IBD to be more prevalent disorder among elderly patients. However, the mortality and outcomes of geriatric patients hospitalized for management of IBD remain understudied.
Using ICD-10 codes, the National Inpatient Sample database of the years 2016 to 2019 was screened for to geriatric (≥ 65 years old) and non-geriatric adult (18-65 years old) population who were hospitalized with a primary diagnosis of IBD (Crohn’s Disease and Ulcerative Colitis). Multivariate logistic regression analysis was performed to compare the mortality and hospital complications risks of elderly patients (Study group) hospitalized for IBD to that of younger group (Controls). Baseline patients and facilities characteristics were incorporated into the analysis. Data was considered statistically significant if p-value was <0.05.
Among 953,094 adults’ patients who were hospitalized in US with a primary diagnosis of IBD from 2016 - 2019, 370,424 (38.9%) were ≥ 65 years old. Age-stratified patients baseline characteristics are listed in Table 1. In term of mortality, Geriatric patients were found to have a 2.50-fold increase in risk of mortality (OR 2.50, 95% CI 2.29– 2.72, p<0.001) when compared to younger adults. In term of in-hospital outcomes (Figure 1), Geriatrics patients had a higher risk of sepsis (OR 1.21, 95% CI 1.16– 1.26, p< 0.001), septic shock (OR 1.44, 95% CI 1.34– 1.54, p< 0.001), acute kidney injury (OR 1.43, 95% CI 1.38– 1.48, p< 0.001), acute coronary syndrome (OR 1.52, 95% CI 1.36 – 1.70, p<0.001), in-hospital cardiac arrest (OR 1.29, 95% CI 1.09 – 1.53, p= 0.003), UTIs (OR 1.93, 95% CI 1.86 – 2.01, p< 0.001), pneumonia (OR 1.36, 95% CI 1.30 – 1.43, p< 0.001), acute respiratory failure (OR 1.41, 95% CI 1.34 – 1.48, p<0.001) and mechanical ventilation (OR 1.13, 95% CI 1.05 – 1.23, p=0.001) when comparted to non-Geriatrics patients. Interestingly, Geriatrics/IBD patients had no significant difference in length of stay (Coefficient 0.09 days, 95% CI -0.009 –0.172, p<0.028) and cost of care (Coefficient 403$, 95% CI -937 – 1745, p=0.55) when compared to younger subjects.
Elderly patients hospitalized for management of IBD have higher rates of mortality, sepsis, septic shock, acute kidney injury, acute coronary syndrome, in-hospital cardiac arrest, UTIs, pneumonia, acute respiratory failure and mechanical ventilation, with no significant difference in healthcare resources utilization compared to younger subjects. These results are likely related to the higher comorbidities and the benefits/risk balance of undergoing invasive therapeutic measures in this friable age group.
