- Fecal Incontinence
|Rising Rate of Obesity in Patients Admitted for Crohn's Disease Increases Costs But Not Mortality
J Clin Gastroenterol. 2021 Sep 1;55(8):716-720. doi: 10.1097/MCG.0000000000001421.
Megan Lipcsey 1, Daniel J Stein 2, Zachary G DeVore 3, Joseph D Feuerstein 4
1Department of Medicine.
2Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston.
3Department of Gastroenterology, University of Massachusetts Memorial Medical Center, North Worcester, MA.
4Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School.
Goal: The goal of this study was to compare outcomes and trends for inpatients with Crohn's disease (CD) and obesity.
Background: Obesity is a growing concern in the United States. Current data on the effect of obesity on the course of the CD are conflicted.
Methods: Data from the 2016 to 2017 National Inpatient Sample were compared for obese, normal weight, and malnourished patients. After adjustment for comorbidities, demographics and disease type/inpatient surgery, outcomes including mortality, length of stay, hospitalization charges, and rates of deep venous thrombosis (DVT) in obese and malnourished patients were compared with those with normal body mass index using multivariable regression. For trend analysis, rates of obesity were compared from 2002 to 2017.
Results: The percentage of patients with CD and obesity increased from 1.8% in 2002 to 9.5% in 2017 (0.5% per year, P<0.001). Rates of death were similar in obese versus normal-weight CD patients [odds ratio (OR)=1.21, 95% confidence interval (CI): 0.85-1.73, P=0.288]. In contrast, obese CD patients had increased length of stay (1.0 d, 95% CI: 0.81-1.26, P<0.001), cost ($8323, 95% CI: 5565-11,082, P<0.001), and DVT rate (OR=1.67, 95% CI: 1.13-2.46, P=0.01). Malnourished CD patients had OR for death of 2.15 (95% CI: 1.71-2.70, P<0.001) compared with normal-weight cohort. Similarly, length of stay, cost, and DVT rate were all increased.
Conclusions: Rates of hospitalized CD patients with obesity are increasing. Patients with obesity and CD have increased length of stay and costs, with no mortality difference. Malnourished CD patients continue to have higher mortality, length of stay, and cost. Obesity is a risk factor for adverse hospitalization outcomes.