Ulcerative Colitis (UC)-Associated Colorectal Cancer (CRC) Patients Who Receives Colorectal Surgery More Likely Receive Blood Transfusion Than Crohn’s.

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Ulcerative Colitis (UC)-Associated Colorectal Cancer (CRC) Patients Who Receives Colorectal Surgery More Likely Receive Blood Transfusion Than Crohn’s Disease (CD)-Associated CRC Patients- A Propensity Match Study Cheng Zhang MD, PH.D, FACG Inflammatory Bowel Disease Program, Division of Gastroenterology, Hepatology, & Nutrition The Ohio State University Wexner Medical Center Columbus, OH, USA

Background Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (CRC). Risks of CRC in IBD patients increases with duration of disease. Pathophysiology of development of CRC in IBD is probably different than in sporadic CRC. The prognosis of CRC in IBD patients is controversial. IBD is associated with poor outcomes of surgery for diverticular disease, however, the outcomes of colorectal surgery in IBD-associated CRC was unknown. Adherence to national surveillance guideline for CRC in IBD patients was poor.

Aims To compare the health care resource utilization, particularly the requirements of blood transfusion, between Ulcerative colitis (UC)- and Crohn’s disease (CD)-associated CRC who receives colorectal surgery

Methods Study Design: A cross-sectional study Data Source: The Nationwide Inpatient Sample (NIS) database (2008-2012) Patients Selection: UC, and CD, and colorectal cancer (CRC) were identified using appropriate ICD-9-CM codes. Primary Outcomes: Requirements of blood transfusion. Secondary Outcomes: The location of cancer. The surgery location

Statistical Analysis Healthcare outcomes: Propensity match analysis using McNemar’s tests. Cancer Location and surgical location: Multivariate regression models SAS 9.3, Cary, NC.

Matched patients’ characteristics

Matched patients’ characteristics

Matched patients’ characteristics

Outcomes UC-associated CRC patients who receive colorectal surgery more likely receive blood transfusion when compared with CD-associated CRC patients.

Cancer Location and Surgery Location *Adjusted for age, gender, race, insurance, income, Elixhauser score, hospital size, type, and region.

Limitations Large database analysis- Coding errors. The NIS database does not provide information of the stage of cancer. Whether patients have received chemotherapy, radiation therapy, or immunosuppressants was unknown

Conclusions Colorectal surgery in UC-associated CRC patients has been associated with higher health care resource utilization, including blood transfusion, when compared with CD-associated CRC . The location and type of colorectal surgery are also different between UC- and CD-associated CRC. This study suggested that the surgical treatment for UC- and CD-associated CRC is different and therefore, care of IBD-associated CRC around colorectal surgery should be treated differently between UC and CD patients.