Title

Impact of Pandemic on Epidemiology and Management of Acute Colonic Pseudo Obstruction: Nationwide Clinical Data Research Network

Abstract

Introduction Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie’s syndrome, is characterized by massive acute dilatation of the large intestine without a mechanical cause. Early recognition to identify serious adverse events such as ischemia/ perforation is critical to reducing mortality rates. COVID-19 pandemic led to a significant shift of resources for the treatment of patients with reduced utilization of endoscopy and imaging, which could have impacted outcomes in patients with ACPO. In this study, we aim to identify the change in the clinical outcomes in ACPO patients in 2020.

Methods All adult patients with a new diagnosis of intestinal obstruction without mechanical cause were identified using ICD-10 codes (K59.8, K56.69). Patients diagnosed with megacolon (K59.3) were excluded. Patients were included from TriNetX, a federated cloud-based network that comprises 92 healthcare organizations across the entire US. The primary outcomes were rates of pharmacological therapy (neostigmine use), lower GI endoscopic decompression (Colonoscopy/sigmoidoscopy), surgery (laparotomy), and overall 30 day- mortality. The outcomes were measured after 1:1 propensity matching of the groups based on the baseline demographics and comorbidities.

Results A total of 24,310 patients were diagnosed with ACPO in 2020 compared to 95,014 with a reduced incidence of 74.5%. Comorbidities of these patients at presentation and clinical outcomes are noted in Table 1. Patients with behavioral/neurodevelopmental disorders, obesity, opioid use and laxative were significantly higher in ACPO patients. After matching, rates of neostigmine use (risk ratio [RR]- 0.71 (CI- 0.41 – 1.23)), imaging (CT/MRI) (RR- 0.86 (CI- 0.72 – 1.03)), surgery ((RR- 0.93 (CI- 0.83 – 1.03)) did not differ between the groups. Endoscopic utilization reduced significantly in 2020 (RR- 0.86 (CI- 0.78 – 0.95)). Furthermore, mortality was low in 2020 group (RR- 0.74 (CI- 0.65 – 0.84)).

Discussion The rates of ACPO diagnosis in 2020 reduced by 74.5% compared to 2019. Although the neostigmine use, cross-sectional imaging use, and surgery rates did not change, endoscopic utilization was reduced by 15%. This was noted despite a need for urgent endoscopic decompression needed in these patients. Interestingly, the mortality was also reduced by 26% in 2020-ACPO groups even after lower utilization rates of endoscopy.

Document Type

Article

Publication Date

10-2021

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