P066  Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis.

P066  Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis.

 

Palacio Flávia1, Zaltman Cyrla2, de Souza Heitor3, Moreira Jessica3, Luiz Ronir3, de Souza Lucila1
1 Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 2 Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 3 Universidade Federal do Rio de Janeiro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic diseases of the gastrointestinal tract with increasing incidence worldwide and prevalence in the last few decades. Surgical risks related to IBD have not been well characterized. Furthermore, there is a growing interest in the management of these diseases with a goal of understanding the changes in their behavior and relation to demographic factors affecting IBD population distribution, with the objective of proposing earlier and more effective interventions. Objective: The aim of this study is to evaluate IBD-related hospitalization and surgical rates in Brazil, geographical distribution, time trends ,and mortality associated with surgical procedures.
 

METHODS: Methods: Data from hospital admission registries, available in the Brazilian health system national bank (DATASUS), were retrospectively collected, regarding IBD-related hospitalizations (identified using ICD-10), frequency of hospitalizations, surgeries, and deaths related to surgical procedures, as well as sociodemographic data, from January 2005 to December 2015.

RESULTS: Results: Hospitalization rates in Brazil decreased by 24% in the analyzed period, and proportion of surgeries related to IBD decreased by 35.2%. The largest proportion of surgeries occurred in Crohn`s disease (CD) patients, mostly young adults (age 20-39 years followed by 40-59 years) and female patients. Enterectomy was the most performed surgery. Surgical mortality decreased by 46% (19.8% in 2005 to 10.6% in 2015).  The most economically developed regions of the country and metropolitan integrated municipalities presented the highest hospitalization and surgical rates. The poorest regions and non-integrated metropolitan municipalities presented the highest mortality rate related to surgery.

CONCLUSION(S): Conclusions: Brazil follows the global decrease in surgical procedures, mortality and hospitalizations related to IBD. Moreover, the observed distribution of hospitalizations and surgeries was unequal, prevailing in the wealthiest and more developed regions. Early diagnosis and referral to a specialized gastroenterologist for a structured management plan may contribute to a reduction of surgical hospitalization and mortality rates related to IBD. Brazil, a continental country, with distinct geographic areas and socioeconomic disparities, needs a more integrated health system, with better distribution of IBD referral services.