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Non-gastroenterologist care can increase mortality risk in ulcerative colitis patients
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Patients with ulcerative colitis under gastroenterologists’ care are at reduced risk for in-hospital mortality compared with patients receiving treatment from non-gastroenterologists, according to recent results.
In a population-based cohort study, researchers evaluated 4,278 patients with ulcerative colitis (UC) admitted to hospitals in Ontario, Canada, between 2002 and 2008. Of these patients, 1,528 (35.7%) were admitted to a gastroenterologist, 1,080 (25.3%) to another type of internist, 983 (23.0%) to a general practitioner and 687 (16.1%) to a general surgeon. The study was designed to determine whether care provided by gastroenterologists as opposed to nonspecialists reduced in-hospital mortality risk.
In-hospital death occurred in 0.75% of all patients, and 8.4% received a colectomy. Patients treated by non-gastroenterologists had a significantly higher in-hospital mortality rate (1.1% compared with 0.2% among patients treated by gastroenterologists, P<.0001), but had a similar rate of colectomy (5.4% vs. 4.9%, P=.69).
After adjusting for covariates, investigators found that care under non-gastroenterologists was associated with increased risk for in-hospital mortality (adjusted OR=3.28; 95% CI, 1.03-10.5) compared with care by gastroenterologists. This increased risk existed for patients admitted to internists (OR=5.49; 95% CI, 1.75-17.2) and general practitioners (OR=6.02; 95% CI, 1.84-19.7), and a trend toward increased risk also was observed for patients treated by general surgeons (OR=3.49; 95% CI, 0.90-13.6).
Patients discharged without undergoing colectomy had a significantly higher mortality rate within 1 year if admitted to a non-gastroenterologist (4.04% vs. 1.41% having received gastroenterologist care, P<.0001) and were found to be at greater risk for mortality if seen by other internists (adjusted OR=1.92; 95% CI, 1.06-3.47), general practitioners (adjusted OR=2.18; 95% CI, 1.29-3.69) or general surgeons (adjusted OR=2.34; 95% CI, 1.22-2.54).
“This study is the first to evaluate the impact of provider care on health outcomes of hospitalized UC patients,” the researchers wrote. “However, these results require confirmation in other healthcare settings before they can be generalized to all hospitalized UC patients. Furthermore, specific differences in provider care strategies that impact outcomes in this population require elucidation to provide potential targets for future educational and healthcare policy initiatives. Nevertheless, until that time, it may be prudent for hospitalized UC patients to be managed by physicians with expertise in [inflammatory bowel disease].”
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