Optimizing Surveillance Colonoscopy For Ulcerative Colitis-Associated Colorectal Cancer By Assessing Surgically Resected Cases: A Multicenter Retrospective Study

INTRODUCTION Ulcerative Colitis (UC) and chronic Hepatitis C (HCV) management has been evolving rapidly over the past decade, with new therapies changing the landscape of disease.No prior study has examined the impact of HCV on the severity of UC in hospitalized patients.The aim of this study was to explore the impact of HCV infection on inpatient outcomes of patients with UC.METHODS This was a retrospective cohort study using the 2013 National Inpatient Sample, the largest publically available inpatient database in the United States.All patients with a principal ICD-9 CM diagnosis code for UC and HCV were included in the study.There were no exclusion criteria.The primary outcome was inhospital mortality.The secondary outcomes were morbidity as measured by malnutrition, intensive care (ICU) admission, shock, multi-organ failure (MOF), and need for colectomy; resource utilization, measured by TPN use, need for colonoscopy, hospital length of stay (LOS), and economic impact, measured by total hospital costs and total hospitalization charges.Means and proportions were compared using Student's t-test and Fisher's exact test, respectively.Odds ratios and means were adjusted for the following confounders using multivariate regression analyses: age, sex, race, median income in the patient's zip code, Charlson Comorbidity Index, hospital region, rural location, size and hospital teaching status.RESULTS A total of 37,610 patients with UC were included in the study, of which 440 had a diagnosis of HCV.The mean age was 45 years and 52% were female.Table 1 shows all adjusted odds ratios, adjusted means and p values.The unadjusted in-hospital mortality in patients with UC and comorbid HCV was greater than patients with UC alone (3.0% vs 1.9%, p<0.01).However, on multivariate analysis, there was no statistical difference in mortality between HCV and non-HCV infected patients with UC (OR: 4.27, 95%CI: 0.79-22.86,p=0.09).The HCV-infected cohort had greater colonoscopy use and total hospitalization costs when compared to the non-HCV infected.There was no significant difference in ICU admission, shock, multi-organ failure, colectomy rates, TPN use, total hospitalization charges, or hospital LOS between the two cohorts.CONCLUSIONS While not statistically significant, there appears to be a trend in the risk of mortality in patients with UC and comorbid HCV infection who are admitted to the hospital with UC.HCV infection in patients with UC is associated with an increased need for colonoscopy.Interestingly, HCV infection results in significantly decreased total hospitalization charges, but not hospital costs, which likely represents an influence of reimbursement models.Further studies aimed at larger population cohorts are warranted to further assess the impact of HCV status on patients with UC.Table 1: Adjusted Values of Measured Outcomes Sa1862