P124 In-patient burden of IBD: analysis of 16,000 admissions in the Lothian IBD Registry (LIBDR)

IntroductionThe Lothian IBD Registry (LIBDR) is a comprehensive record of all cases of IBD in Lothian, a geographical area in South East Scotland with a population of approximately 900,000. The current IBD prevalence in Lothian is 0.79% and predicted to reach 1% by 2028. We aim to describe all-cause admission characteristics for IBD patients over the last 10 years and predict the consequences to healthcare provision as IBD prevalence continues to grow.MethodsThe LIBDR was compiled through a capture-recapture derived prevalence estimation of IBD in Lothian1. Hospital admission rates for this cohort were derived using pre-existing registries and electronic health record linkage by community health index (CHI) number, a unique identifier covering 100% of the population, between 01/01/2010 (start of electronic recording of data) and 30/09/2019. All admissions <24 hour duration were excluded. All diagnosis codes were recorded using the ICD-10 system. Primary care prescription data was recorded using British National Formulary (BNF) codes. Clinic attendance data was available from 01/01/2015.ResultsThere were 17,836 hospital admissions for 3,400 of the 8,255 patients in the LIBDR prevalent cohort in the study period. Overall the number of admissions per prevalent case is decreasing over time (figure 1(a)). IBD was the primary reason for admission in 3,715 of those admissions for 1,775 patients. Median length of stay for all admissions was 4 nights (IQR 2–9). Admissions for the cohort accounted for 202,857 bed-days, an average of 23,000 per year. The commonest reason for admissions was infection (4,639 admissions for 2,064 patients,15% of admissions), followed by Crohn’s disease (K50.*,11.3% of admissions) and ulcerative colitis (K51.*,9.5%). Of the patients admitted for infection, 88 patients required 197 ICU admissions. A primary care prescription for an antimicrobial, steroid, opioid or cytotoxic drug was given before 116 of these ICU admissions. Less than half of patients admitted after 01/012015 were seen in clinic within 180 days prior to admission (400/870 patients). Despite this, the number of appointments per prevalent case is increasing over time with a marked difference between age groups (figure 1(b)). Hospital re-admission analysis showed 3,715 index admissions for IBD with 177 (5%) readmissions within 7 days of discharge, 313 (8%) within 14 days and 498 (13%) within 30 days. In most cases, the reason for readmission was also IBD. However, infection and abdominal pain accounted for 10% of readmissions.ConclusionsThe current burden of on hospital resources from the IBD population is high. With prevalence continuing to rise, service planning will be essential to provide care for these patients.ReferenceJones, G.R. et al. Gut ( 2019)