Characterizing Regionalization of Inflammatory Bowel Disease Hospitalizations and Operations in Washington State

BACKGROUND

Hospitalizations for inflammatory bowel disease (IBD) are a major contributor of healthcare utilization. We assessed IBD hospitalizations and surgical operations in Washington State to characterize regionalization patterns.

METHODS

We identified a cohort of hospitalizations for Crohn's disease (CD) or ulcerative colitis (UC) from 2008 to 2019 using Washington State's Comprehensive Hospital Abstract Reporting System (CHARS). Hospitalizations were characterized by emergent or elective acuity and whether an operation or endoscopic procedure was performed. Facility volume and distance travelled by patients were used to determine regionalization.

RESULTS

There were 20,494 IBD-related hospitalizations at 95 hospitals: 13,585 (66.3%) with CD and 6,909 (33.7%) with UC. Emergencies accounted for 78.2% of all IBD-related hospitalizations and did not differ between CD (78.3%) and UC (77.9%) (p = 0.54). Surgery was performed during 10.3% and endoscopy during 30.6% of emergent hospitalizations. 72.0% of emergent hospitalizations occurred at 22 facilities, while 71.1% of elective hospitalizations were concentrated at 9 facilities. Operations were performed during 78.5% of elective hospitalizations, and five hospitals performed 69% of all elective surgery. Laparoscopic surgery increased in both emergent (17% to 52%, p < 0.001) and elective operations (18% to 42%, p < 0.001) from 2008 to 2019.

CONCLUSIONS

In Washington State, most IBD hospitalizations were emergent, which were decentralized and typically non-operative. By contrast, most elective admissions involved surgery and were centralized at a few high-volume centers. Further understanding the drivers behind IBD hospitalizations may help optimize emergent medical and elective surgical care at a state level.

Role of hospitalization for inflammatory bowel disease in the post-biologic era

Treatment for inflammatory bowel disease (IBD) often requires specialized care. While much of IBD care has shifted to the outpatient setting, hospitalizations remain a major site of healthcare utilization and a sizable proportion of patients with inflammatory bowel disease require hospitalization or surgery during their lifetime. In this review, we approach IBD care from the population-level with a specific focus on hospitalization for IBD, including the shifts from inpatient to outpatient care, the balance of emergency and elective hospitalizations, regionalization of specialty IBD care, and contribution of surgery and endoscopy to hospitalized care.

Feasibility of injected indocyanine green for ureteral identification during robotic left-sided colorectal resections

BACKGROUND

Ureteral identification is essential to performing safe colorectal surgery. Injected immunofluorescence may aid with ureteral identification, but feasibility without ureteral catheterization is not well described.

METHODS

Case series of robotic colorectal resections where indocyanine green (ICG) injection with or without ureteral catheter placement was performed. Imaging protocol, time to ureteral identification, and factors impacting visualization are reported.

RESULTS

From 2019 to 2020, 83 patients underwent ureteral ICG injection, 20 with catheterization and 63 with injection only. Main indications were diverticulitis (52%) and cancer (36%). Median time to instill ICG was faster with injection alone than with catheter placement (4min vs 13.5min, p < 0.001). Median time [IQR] to right ureter (0.3 [0.01-1.2] min after robot docking) and left ureter (5.5 [3.1-8.8] min after beginning dissection) visualization was not different between injection alone and catheterization.

CONCLUSION

ICG injection alone is faster than with indwelling catheter placement and equally reliable at intraoperative ureteral identification.

Cutaneous application of vegetable oil as a coadjutant in the nutritional management of preterm infants

BACKGROUND

The cutaneous application of vegetable oil as a therapeutic practice and dietary coadjuvant has been described mainly in adult patients at risk for essential fatty acid deficiency. In the current study, the effects of cutaneous soybean oil application on somatic growth and plasma linoleic and arachidonic acid levels were examined in enterally fed preterm newborns.

METHODS

Sixty consecutive preterm infants were chosen from patients admitted to the nursery. Infants were randomly assigned to one of two groups: the oil group, which was treated cutaneously with soybean oil, or the control group, which received no cutaneous treatment.

RESULTS

After 30 days, a significant increase in anthropometric parameters was observed in infants who received cutaneous oil, mainly in infants small for gestational age. An increase in linoleic acid level and a decrease in arachidonic acid level were seen in both groups but do not justify the difference found in growth rates in the control and oil groups.

CONCLUSIONS

Preterm infants treated cutaneously with soy oil showed better somatic growth than the control group. The factors leading to the present results, especially the response of the infants who were small for gestational age merit further evaluation.