Predictors of Intestinal Obstruction in Hospitalized Patients with Inflammatory Bowel Disease: A Retrospective Analysis

Abstract

Background Inflammatory bowel disease (IBD) is a complex condition that has a variety of gastrointestinal (GI) and extra-intestinal manifestations (EIM). IBD consists of Crohn’s disease (CD) and ulcerative colitis (UC), both of which can lead to several complications including abscess, fistula formation, bleeding, obstruction, and malignancy. Bowel obstruction is associated with significant morbidity, mortality, and healthcare burden. Our study aims to assess predictors of developing intestinal obstruction in hospitalized patients with IBD. Methods Patients with a diagnosis of IBD were identified using the Nationwide Inpatient Sample (NIS) 2016-2020. IBD patients were identified using ICD-10 codes. Patients <18 years and with a diagnosis of both UC and CD were excluded. Patients were stratified based on the presence of intestinal obstruction during hospitalization. Data were collected regarding age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. Other variables included presence of fistula, abscess, bleed, colorectal cancer (CRC), diverticulitis, and Clostridium difficile infection (CDI). The association between variables and primary outcome of intestinal obstruction was evaluated using multivariate regression analysis. Results A total of 1,517,485 patients with IBD were included in the final analysis. Among these, 10.1% had intestinal obstruction. The patients with IBD and intestinal obstruction were younger, 18-44 yrs (40.3%), female (51.3%), White (80.3%) and had Medicare insurance (32.5%). After adjusting for confounding factors, fistula (aOR 1.19, p< 0.001, CRC (aOR 2.94, P < 0.001), and tobacco use (aOR 1.09, P < 0.001) had higher odds of developing intestinal obstruction during hospitalization. Patients with abscess (aOR 0.91, P = 0.04), bleeding (aOR 0.22, P < 0.001), Hispanic race (aOR 0.86, P < 0.001), and female sex (aOR 0.76, P < 0.001) had lower odds of developing obstruction. Conclusion Our study found factors associated with higher and lower odds of developing bowel obstruction. Disparities were noted based on race and gender regarding the odds of developing obstruction. Further studies are needed to elucidate the mechanisms driving these findings.