Sa1802 1.42; 95% CI 1.35, 1.50) and CD patients (OR 1.12; 95% CI 1.05, 1.

19) were more likely

to develop complications. Compared to Caucasians, African Americans had higher odds of
DOES CLOSTRIDIUM DIFFICILE INCREASE THE RISK OF READMISSION postoperative morbidity (OR 1.15; 95% CI 1.04, 1.28). Conclusion: Despite increased
IN IBD? hospitalizations for IBD, rates of TAC have declined significantly (Figure 1). This may reflect
Abhinav Goyal, Surbhi Abrol, Kshitij Chatterjee, Kamolyut Lapumnuaypol, Janani the effect of the introduction and expansion of biologic therapy. For IBD patients who
Rangaswami, Shailender Singh undergo TAC, postoperative mortality has declined significantly while postoperative morbid-
ity remains stable. Older age, race and emergent admissions are predictive factors of both

AGA Abstracts
Introduction: Clostridium difficile colitis (CDI) is known to have a greater prevalence in
postoperative morbidity and mortality.
patients with inflammatory bowel disease (IBD) compared to general population. It is cause
of significant morbidity in these patients and has implications on management of IBD
especially in an acute hospital based setting. It is also known that patients with IBD have
a high readmission rate which can significantly impact cost of healthcare. Our aim is to
assess the thirty day readmission rate and if presence of CDI during index admission increases
the readmission rate in patients with IBD. METHODS Nationwide Readmissions Database
2014 was used for this study. It is the largest ICD-9 code based inpatient readmission
database in the US. Presence of ICD-9-CM codes 555.x or 556.x as prinicipal diagnosis in
any adult were used to identify index admission with IBD. Any hospitalization within thirty
days of the index admission was considered a readmission. All hospitalizations with missing
age or gender information, and index discharge in December were excluded. Demographic
characteristics and outcomes were summarized using mean/median for continuous variables
and percentages for categorical variables. Two level mixed effect parametric survival model
with random effect at hospital level was used to identity predictors of readmission after
adjusting for demographics, co-morbidities, and hospital characteristics. Data was right
censored at discharge. Stata 14.0 (Stata corp., Collegetown, TX) and SPSS 23.0 (SPSS Inc.,
Chicago, IL) were used for all statistical analysis. RESULTS Total of 61,529 index admissions
for IBD were identified. 11,465 (18.6%) of these were readmitted at least once within thirty
days. Common reasons for readmission are summarized in Figure 1. 39.3% of all readmissions
were related to IBD. Medicare (HR=1.43, p<0.001) or Medicaid (HR=1.26, p<0.001) com-
pared to private insurance, older age (40-64yrs: HR=0.85, p<0.001; >65 yrs: HR=0.69,
Trends in Hospitalization and Total Abdominal Colectomy amongst IBD patients from 1998
p<0.001), presence of depression (HR=1.21, p<0.001), drug use (HR=1.36, p<0.001), other
to 2013
psychiatric co-morbidites (HR=1.27, p=0.002) were important predictors of readmission.
CDI during index admission was not a predictor of thirty day readmission in IBD (HR=
1.07, p=0.47) although the prevalence of CDI was significantly higher during readmission
compared to index admissions (7.4% vs 2.8%, p<0.0001). CONCLUSION 18.6% of patients
with IBD were readmitted atleast once within thirty days. Medicare or Medicaid, older age,
psychiatric co-morbidites, depression, and drug use were important predictors of readmis-
sion. Clostridium difficile infection during index admission did not increase the risk of
readmission although it was significantly more common during readmissions than index
admissions.

Sa1803

TOTAL ABDOMINAL COLECTOMY AMONGST HOSPITALIZED PATIENTS

WITH INFLAMMATORY BOWEL DISEASE IN THE BIOLOGIC ERA:
EVIDENCE FROM THE NATIONAL INPATIENT SAMPLE (1998 - 2013)
Babatunde Olaiya, Benjamin D. Renelus, Mikolaj Filon, Deola Saheed, Sultan Mahmood
Background: Total abdominal colectomy (TAC) is a treatment modality of last recourse for
patients with severe and/or refractory inflammatory bowel disease (IBD). Advancements in
medical therapy including biologics may have altered the uptake and/or outcomes of TAC.
The goal of this study is to evaluate temporal trends and outcomes of TAC in hospitalized
IBD patients in the biologic era (1998-2013). Methods: We queried the National Inpatient
Sample (NIS) to identify patients older than 18 years with a primary diagnosis of Ulcerative
colitis (UC) or Crohn's disease (CD) who underwent TAC between 1998 and 2013. Data
on age, gender, race, comorbidities, elective versus emergent admission, urban versus rural
and location were extracted and analyzed. We evaluated postoperative morbidity and mortal-
ity as secondary outcomes of interest (Table 1). Logistic regression was used to explore
factors associated with undergoing a TAC as well as postoperative outcomes. Results: We
identified 1,321,166 hospitalizations (UC: 492509) with a primary diagnosis of IBD. Of
these, 57,784 (4.4%) resulted in TAC. Between 1998 and 2013, hospitalizations for IBD
increased by 50% however the rates of TAC dropped significantly from 5.2% to 3.8% List of complications after total abdominal colectomy (postoperative morbidity)
(p<0.001). Compared to CD, UC patients were more likely to get a TAC (OR 8.43, 95%
CI 8.18, 8.67). Overall, postoperative mortality after TAC was 2.2%. This reduced from
3.7% in 1998 to 1.2% in 2013 (p < 0.001). On multivariate analysis, predictors of postopera-
tive mortality include age > 50 years (OR 12.70, 95% CI 9.78, 16.49), non-elective hospitali-
zations (OR 5.96; 95% CI 5.00, 7.10) and rural hospital procedures (OR 2.03, 95% CI
1.53, 2.68). Compared to Caucasians, Blacks and Hispanics had higher odds of postoperative
mortality (OR 2.21; 95% CI 1.61, 3.02) and (OR 1.73; 95% CI 1.24, 2.42) respectively.
Overall, postoperative morbidity after TAC was 29.1%. It increased from 25.9% in 1998 to
36.1% in 2008 but dropped thereafter. After adjusting for covariates, female sex (OR 1.50;
95% CI 1.43, 1.57), non-elective admission, (OR: 1.66; 95% CI 1.58 -1.76), age >50 (OR:

S-407 AGA Abstracts