Weekend Surgical Admissions of Pediatric IBD Patients Have a Higher Risk of Complication in Hospitals Across the US

Background: Weekend surgical admissions to the hospital are associated with worse clinical outcomes when compared with weekday admissions. We aimed to evaluate the association of weekend admission and in-hospital complications for pediatric inflammatory bowel disease (IBD) hospitalizations requiring urgent abdominal surgery. Methods: We performed a cross-sectional analysis of pediatric (18 years old and younger) IBD hospitalizations between 1997 and 2016 using the Kids' Inpatient Database (KID), a nationally representative database of pediatric hospitalizations. We included discharges with a diagnosis code for Crohn's disease (CD) or ulcerative colitis (UC) undergoing a surgical procedure within 48 hours of admission. We used logistic regression to evaluate the association of weekend admission and complications, controlling for confounding factors. Results: Our study included a total of 3255 urgent surgical hospitalizations, representing 4950 hospitalizations nationwide. The risk difference for weekend CD surgical hospitalizations involving a complication vs weekday hospitalizations was 4%. Adjusted analysis demonstrated a 30% increased risk for complications associated with weekend CD hospitalizations compared with weekday hospitalizations (OR 1.3, 95% CI, 1.0-1.7). The risk difference for weekend UC hospitalizations involving a complication compared with the weekday hospitalizations was 7%. Adjusted analysis demonstrated a 70% increased risk of complication for UC weekend surgical hospitalizations compared with weekday hospitalizations (OR 1.7, 95% CI, 1.2-2.3). Conclusion: Pediatric IBD hospitalizations involving urgent surgical procedures have higher rates of complications when admitted on the weekend vs the weekday. The outcome disparity requires further health services research and quality improvement initiatives to identify contributing factors and improve surgical outcomes

Patients Who Undergo Colectomy for Pediatric Ulcerative Colitis at Low-Volume Hospitals Have More Complications

Background & Aims: Adults with ulcerative colitis (UC) who undergo colectomy at high-volume centers have better outcomes and fewer complications than those at low-volume centers. We aimed to evaluate the hospital volume of total abdominal colectomy (TAC) for pediatric patients with UC and explore time trends in the proportion of colectomies performed at high-volume centers. We then evaluated the association between hospital colectomy volume and complications. Methods: We performed a cross-sectional analysis of pediatric patients (age, ó18 y) hospitalized for UC using the Kids? Inpatient Database, a nationally representative database of pediatric hospitalizations. We identified UC hospitalizations with a procedural code (International Classification of Diseases, 9th or 10th revision) for TAC from 1997 through 2016. We defined complications using diagnosis codes adapted from published algorithms. We defined high-volume as hospitals that performed 10 or more TACs annually. We used multivariate statistics to evaluate the association between hospital volume and in-hospital complications. Results: A total of 1453 hospitalizations of children with UC included a TAC (2306 colectomies nationwide). A total of 766 hospitals performed 1 or more annual colectomies and only 36 (4.7%) were high-volume hospitals, accounting for 21% of colectomies. The proportion of colectomies at high-volume hospitals decreased over time. The absolute risk of complication was 16% at high-volume centers compared with 22% at low-volume centers (adjusted odds ratio, 0.7; 95% CI, 0.5?0.9). The effect of annual TAC volume on complication risk was not statistically significant for nonemergent admissions. Conclusions: Pediatric patients with UC who undergo colectomy at high-volume centers have fewer complications. However, only a small proportion of pediatric colectomies (<5%) are performed at high-volume centers

Reply to Dai et al.

To the Editor: My colleagues and I appreciate the interest in our epidemiological finding that affective-cognitive symptoms of depression are associated with subsequent exacerbation of Crohn's disease, controlling for multiple confounders. The letter by Dai et al. raises a number of important clinical implications and suggests several areas of future investigation

COVID-19 Vaccination Among Individuals With Inflammatory Bowel Disease: Perception, Efficacy, and Safety

The COVID-19 pandemic, caused by SARS-CoV-2, has been the most significant global health crisis of the past century. The development of safe and effective vaccines has led to a reduction in COVID- 19-related hospitalizations and deaths; however, the clinical trials that led to US Food and Drug Administration Emergency Use Authorization and/or approval of the vaccines in the United States did not include individuals with inflammatory bowel disease (IBD). Because individuals with IBD are commonly treated with immunosuppressive medications, there had been concern for reduced vaccine efficacy in this population. This article provides an overview of the peer-reviewed literature addressing COVID-19 vaccination in individuals with IBD; details the perceptions of patients with IBD of COVID-19 vaccines, including how gastroenterologists can help to reduce vaccine hesitancy; and describes the humoral immune response to COVID-19 vaccines, with a majority of patients with IBD seroconverting following complete vaccination regardless of medication exposure. Additionally, low rates of IBD flare and similar rates of vaccine-related adverse events to those in the general population are described. Finally, the article provides current recommendations from the Centers for Disease Control and Prevention for COVID-19 vaccination in individuals with IBD

Immunosuppression for management of Crohn's disease

We read with interest the study by Reena Khanna and colleagues describing early combined immunosuppression (ECI) for the management of Crohn's disease (REACT trial). The authors aimed to compare the effectiveness of ECI treatment (an anti-TNF drug with antimetabolite treatment) with a conventional step-up approach in a real-life setting

Working Together to Meet the Needs of Patients With Inflammatory Bowel Diseases

We read with interest the article entitled "Coronavirus Disease 2019 (COVID-19): What Should Gastroenterologists and Their Patients Know" by Ungaro et al. The authors provided an informative and concise overview of COVID-19 through the lens of the gastroenterologist. Importantly, they highlighted the paucity of data on the impact of COVID-19 on patients with gastrointestinal disease, including inflammatory bowel disease (IBD). Because COVID-19 is a novel virus, it remains unclear how it will affect our patients, particularly those on immunosuppressive medications. The global gastroenterology community currently lacks the data needed to answer the most pressing questions from our patients: whether their disease places them at higher risk of poor outcomes from COVID-19 and whether they should stop or change current medications

Increasing incidence of pediatric inflammatory bowel disease in France: Implications for etiology, diagnosis, prognosis, and treatment

The significant increase in pediatric-onset inflammatory bowel disease in recent decades appears to be a global phenomenon, with studies from multiple geographic areas noting an increase in Crohn's disease (CD) and ulcerative colitis (UC). In this large, population-based cohort from northern France, the rapid increase in pediatric CD and UC from 1988-2011 may be due to multiple potential etiologies including environmental factors and advancements in diagnostic capabilities. We should consider the clinical implications of this rise in incidence, including potential risk stratification approaches that may offer the ability to modify the disease course of patients with earlier diagnosis

Do Shared Exposures Link the Lungs and Gut? Association Between Asthma and Inflammatory Bowel Disease

Immune-mediated, inflammatory conditions of the gut (eg, inflammatory bowel disease [IBD]) and the lungs (eg, asthma) may be driven by common factors including the interplay between genetic risk factors and environmental exposures that impact the microbiome. The increasing incidence of these immune-mediated conditions in recent years has been attributed frequently to the hygiene hypothesis, which postulates that IBD, asthma, and related immune-mediated conditions are results of improved sanitation including clean water, decreased family size, and improved living conditions. These improvements in hygiene lead to decreased microbial and antigenic exposures (ie, Helicobacter pylori and helminths) early in life, and thus a loss of an early opportunity to prime the immune system

Thrombotic and Infectious Risks of Parenteral Nutrition in Hospitalized Pediatric Inflammatory Bowel Disease

Background Malnutrition is common in inflammatory bowel disease (IBD), requiring timely and sufficient nutritional supplementation. In patients hospitalized for active disease, symptoms and/or altered intestinal function hinder enteral nutrition feasibility. In this scenario, parenteral nutrition (PN) is used. We aimed (1) to assess the frequency of PN use between 1997 and 2012 among hospitalized pediatric patients with IBD, (2) to determine the risk of in-hospital thrombus and infection associated with PN, and (3) to identify predictors of thrombus and infection in pediatric IBD hospitalizations utilizing PN. Methods We performed a cross-sectional analysis of pediatric patients hospitalized between 1997 and 2012. We used the Kids' Inpatient Database (KID) to identify pediatric patients (ó18 years of age) with Crohn's disease (CD) or ulcerative colitis (UC), PN exposure, and primary outcomes including thrombus and infection. We used multivariable regression to identify risk factors for outcomes of interest. Results Parenteral nutrition was utilized in 3732 (12%) of 30,914 IBD hospitalizations. Three percent of PN patients experienced a thrombotic complication, and 5.5% experienced an infectious complication. Multivariate analysis showed PN as an independent risk factor for thrombus (odds ratio [OR], 4.3; 95% confidence interval [CI], 3.2-5.6) and infection (OR, 3.8; 95% CI, 3.1-4.6). Surgery was an independent risk factor for thrombus (OR, 2.0; 95% CI, 1.4-2.7) and infection (OR, 2.5; 95% CI, 2.0-3.1) in hospitalizations exposed to PN. Conclusions Hospitalized pediatric IBD patients, particularly surgical, receiving PN are at increased risk for thrombosis and infection. Clinicians must balance these risks with the benefits of PN

Body Image Dissatisfaction among Pediatric Patients with Inflammatory Bowel Disease

Objectives: To determine risk factors for body image dissatisfaction among pediatric patients with inflammatory bowel disease (IBD). Study design: We performed a cross-sectional study of children aged 9-18 years in the IBD Partners Kids & Teens cohort. Participants completed surveys including demographics, disease characteristics and activity indices, and psychosocial outcomes measured by IMPACT-III questionnaires. We defined body image dissatisfaction if participants answered ?I look awful? or ?I look bad.? Bivariate analyses assessed associations between body image dissatisfaction and demographic, disease-related and psychosocial factors; logistic regression models evaluated associations between risk factors and body image dissatisfaction. Results: IMPACT-III was completed by 664 patients, with 74 (11.1%) reporting body image dissatisfaction. Patients with body image dissatisfaction were more likely to be female (P < .01), older (median age 15 vs 13 years, P < .01), and diagnosed with IBD at an older age (12 vs 10 years, P < .01). Those with body image dissatisfaction had greater body mass index percentile (P = .02), more active disease (P < .01), more current steroid use (P < .01), and more depression and anxiety (P < .01). Female sex (OR 2.31; 95% CI 1.22-4.39), depression (OR 4.73; 95% CI 2.41-9.26), and anxiety (OR 5.42; 95% CI 2.48-11.80) were independently associated with body image dissatisfaction. Conclusions: In this cohort, risk factors for body image dissatisfaction include female sex, older age at diagnosis, active disease, current steroid use, greater body mass index, and comorbid mood disorder. Interventions targeting modifiable risk factors for body image dissatisfaction may improve quality of life in pediatric patients with body image dissatisfaction