P257 Surgical and hospital admission in adults newly diagnosed with inflammatory bowel disease (IBD) in the biological era in Spain: Results of the nationwide EpidemIBD study of GETECCU

Abstract

Introduction: The need for surgery and hospital admission in newly diagnosed inflammatory bowel disease (IBD) patients in the biological era is largely unknown. Aims and Methods: i) To assess the frequency of surgery and hospital admission in an inception cohort of adults newly diagnosed with IBD; ii) to describe the characteristics and indications for surgical interventions; and iii) and to evaluate the causes of hospital admissions. Prospective and population-based nationwide study in Spain. Adult patients diagnosed with IBD -Crohn's disease (CD), ulcerative colitis (UC) or indeterminate colitis (IC)- during 2017 in the 17 Spanish regions were included and followed- up for 12 months after diagnosis. Data were captured in a web-based database (AEG-REDCap). Result(s): 3,469 incident cases from 116 centres covering approximately 50% of the Spanish population were included. Of them, 53% were males, with mean age of 43 years. 50% had UC, 45% CD, and 5% IC. About 14% of patients had a family history of IBD. In CD patients, 55% had ileal and 26% ileocolonic location, and 11% perianal disease. 11% of patients had stenosing and 7% fistulising behaviour at the time of diagnosis. In UC patients, 34% had extensive colitis and 31% left-sided colitis at diagnosis. At present, median follow-up is 3 months (range 0-12 months). 149 patients (4.3%) underwent 188 surgical interventions: 131 (8.3%) in CD and 18 (0.9%) in UC (p<0.01). Regarding the first surgical procedure, 60% were urgent and 60% entailed abdominal surgery (30% for perforation, 28% for stenosis and 26% for abdominal abscess). CD patients with inflammatory behaviour had lower rates of surgery than those with strictures or fistula (5.6%, 14%, and 32%, respectively, p<0.01). Surgery was also more frequent among CD patients with perianal disease than in those without it (34 vs. 5.2%, p=0.01). Other variables, such as family history of IBD, or smoking habit were not associated with the need of surgery. A total of 892 patients (26%) had 1,038 hospital admisions during follow-up, with disease diagnosis as major driver (81%). Median time from diagnosis to admission was 0 months (range 0-9 months). Reasons for hospital admissions are summarized in table 1. Conclusion(s): In this large nationwide inception cohort in the biological era, a substantial proportion of IBD patients underwent surgery, which was urgent in over 2/3 of the cases. Stricturing and fistulizing complications in CD patients were the main drivers for surgery in these patients. 1/4 of patients were hospitalised -most of them at disease diagnosis- within the first 3 months of follow-up. (Table Presented) .