Does It Matter Where You Are Hospitalized for Inflammatory Bowel Disease? A Nationwide Analysis of Hospital Volume

OBJECTIVE: To examine if a high hospital volume was associated with superior outcomes in inflammatory bowel disease (IBD) patients requiring hospitalization. METHODS: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS 2004). IBD-related hospitalizations were identified using appropriate International Classification of Diseases, Ninth revision, Clinical modification (ICD-9-CM) codes. Hospital volume was divided into low, medium, and high by assigning the threshold cutoff values of 1-50, 51-150, and >150 annual IBD hospitalizations, respectively. Our primary outcomes were in-hospital mortality, length of stay, and postoperative complications and stay. RESULTS: Patients at high-volume centers were more likely to be hospitalized with fistulizing or stricturing disease. The adjusted mortality was lower for IBD-related discharges from high-volume centers for those undergoing abdominal surgery (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.18-0.78), but not among those who did not undergo surgery (OR 0.90, 95% CI 0.53-1.52). Patients at high-volume centers were also more likely to undergo surgery (OR 2.24, 95% CI 1.40-3.58). These differences were more prominent in Crohn's disease than in ulcerative colitis. CONCLUSION: Hospitals with a high annual IBD volume have lower in-hospital mortality among surgical IBD patients. This suggests a need for future research into identifying the quality-of-care measures in IBD and instituting appropriate interventions to improve overall IBD outcomes.