Colectomy Subtypes, Follow-up Surgical Procedures, Postsurgical Complications, and Medical Charges Among Ulcerative Colitis Patients with Private Health Insurance in the United States

Background: We describe colectomy subtypes. Follow-up surgical and diagnostic procedures. complications, and direct medical charges occurring Within 180 days of colectomy among privately insured patients with ulcerative colitis (UC). Methods: This was a retrospective analysis 4 an insurance Claims database for 2001-2005. We identified patients with a diagnosis of UC and no Concurrent diagnosis of Crohn's disease Who underwent colectomy. Colectomy types were classified as: 1) total proctocolectomy (TPC) with ileal pouch-anal anastomosis (IPAA). 2) subtotal colectomy (SC) with ileostomy and Hartmann pouch or ileo-rectal anastomosis, 3) TPC with ileostomy, and 4) partial colectomy (PC). follow-up surgical and diagnostic procedures and complications were collected. We developed estimates for UC-relaled charges for hospitalizations, outpatient visits. and medications the time period 180 days before and after colectomy. Results: A total of 55,934 UC patients were identified, of whom 540 had a colectomy and atleast 180 days of pre- and post-colectomy follow-up. The colectomy distribution was: TPC-IPAA. 44%: SC-ileostomy. 22%: TPC-ileostomy. 17%: and PC, 17%. Within 180 days after colectomy, 54% of patients had a second colectomy-related surgery, and 27% had a follow-up diagnostic procedure. Complications following colectomy for UC included: abscesses 11.5% early / 14.6% late), sepsis/pneumonia/bacteremia (9.3% early / 10.0% late), and fistulas (3.9% early / 8.3% late). The mean UC-related direct medical charge for the 180 days following and including initial colectomy was $90,445. Conclusions: In this retrospective study of privately insured UC patients. we observed frequent follow-up surgical/diagnostic procedures, identified several complications postcolectomy. and estimated substantial charges 6 months pre- and postcolectomy.