Abstract and Introduction
Abstract
Background: Inflammatory bowel disease (IBD) services have been particularly affected by the Covid-19 pandemic. Delays in referral to secondary care and access to investigations and surgery have been exacerbated.
Aims: To investigate the use of and outcomes for emergency IBD care during the Covid-19 pandemic.
Methods: Nationwide observational study using administrative data for England (2015–2020) comparing cohorts admitted from 1 January 2015, to 31 January 2020 (pre-pandemic) and from 1 February 2020, to 31 January 2021 (pandemic). Autoregressive integrated moving average forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 to January 2021.
Results: Large decreases in attendances to hospital for emergency treatment were observed for both acute ulcerative colitis (UC, 16.4%) and acute Crohn's disease (CD, 8.7%). The prevalence of concomitant Covid-19 during the same episode was low [391/16 494 (2.4%) and 349/15 613 (2.2%), respectively]. No significant difference in 30-day mortality was observed. A shorter median length of stay by 1 day for acute IBD admissions was observed (P < 0.0001). A higher rate of emergency readmission within 28 days for acute UC was observed (14.1% vs 13.4%, P = 0.012). All IBD procedures and investigations showed decreases in volume from February 2020 to January 2021 compared with counterfactual estimates. The largest absolute deficit was in endoscopy (17 544 fewer procedures, 35.2% reduction).
Conclusion: There is likely a significant burden of untreated IBD in the community. Patients with IBD may experience clinical harm or protracted decreases in quality of life if care is not prioritised.
Introduction
The global covid-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has disrupted the provision of elective and emergency healthcare services.[1,2] In response to the pandemic, both patient behaviour and government policy changed quickly. A national lockdown was instituted in the United Kingdom and the public was advised to stay at home.
It is thought that inflammatory bowel disease (IBD) services have been particularly affected. This is because these services fall under the category of providing care for "benign" diseases. The IBD-UK survey has highlighted the needs of these patients and demonstrated delays in referral to secondary care and access to investigations and surgery even before the pandemic occurred.[3]
In this nationwide observational study, we investigate the process and outcome of secondary and tertiary IBD services during the pandemic in England by:
Comparing the outcome (mortality, length of stay and readmission) of emergency medical IBD care (acute ulcerative colitis and flare of Crohn's disease) in the pandemic with a historical cohort.
Estimating the prevalence of Covid-19 during emergency medical admissions for IBD.
Quantifying the decrease in provision of elective and emergency IBD investigations and procedures during the pandemic with ARIMA models to predict the counterfactual where the pandemic did not occur.
Aliment Pharmacol Ther. 2022;55(7):836-846. © 2022 Blackwell Publishing
