Evaluation of the Quality-of-Care Parameters in Patients With Inflammatory Bowel Disease in Brazilian Hospitals

Abstract Background There are few data on the quality-of-care for inflammatory bowel disease (IBD) in public, private or mixed hospitals, especially in Latin America. The aim of the study was to evaluated clinic and quality parameters and their association with need for ICU and death in Brazilian hospitals. Methods This was a multicentre study carried out in 26 hospitals. Four hundred eighty-eight admissions of patients with IBD were analysed between June 2021 and October 2022. Results The median stay length was 6 days (0–121). The median age was 38 years (16–87), and 265 (54.6%) were female. Three hundred and thirty-nine patients (69.5%) had Crohn's disease (CD) and 149 (30.5%) ulcerative colitis (UC). The median time between symptoms onset and hospital admission was 72 months (1-504) in CD and 49 months (1-300) in UC. In the CD group, there was structural damage in 248 cases (73.2%). UC in pancolitis form was seen in 97 (66%). The Charlson Comorbidity Index (CCI) was scored at least at one point in 182 records (37.3%), and the median was 2 (1-17). Three hundred-seven admissions (62.9%) were urgent, and 208 cases (42.6%) remained in the emergency room (ER) for 2 days (1-22). Disease activity and structural damage accounted for 58.6% of admissions. One-hundred and eighty-three surgeries were performed (37.5%), and 35 (18.1%) postoperative complications were reported. The most prescribed drugs were biologicals (52.8%) before admission and corticosteroids during hospitalization (37.3%). Red days were verified in 45.3%. Intensive care unit (ICU) admission was required in 55 cases (11.3%). One hundred and nine (22.3%) bacterial infections were registered. There were 16 deaths (3.3%), and the main cause was sepsis (37.5%). Surgery, infection, duration of CD symptoms, and CCI were associated with the need for ICU (p= 0.000; 0.000; 0.043; 0.014, respectively). The CCI of 1 best predicted the need for ICU (AUROC 0.588; S 52.7%, E 64.7%). Infection, age, days in the ER, ICU, and CCI were associated with death (p= 0.004; 0.022; 0.006; 0.000; 0.000, respectively). The CCI of 1 is also the best predicted death (AUROC 0.782; S 81.3%, E 64.2%). The need to stay in ER and red days were lower in private and mixed hospitals (p= 0.000). Infection and death rates were similar (p= 0.323). Conclusion A sample with complications associated with IBD but with low CCI due to their younger age was characterized. The majority had CD, and more than 60% of admissions were urgent. The CCI accuracy in predicting ICU and death was obtained. A system deficiency was more evidenced in public hospitals in the rate of individuals who remained in ER. From the red days, greater problem-solving agility was found in private and mixed hospitals.