The provision of, and outcomes for, inflammatory bowel disease services during the COVID-19 pandemic: A nationwide study

ABSTRACT

Background: To investigate the outcome (30-day in-hospital mortality, length of stay and readmission within 28 days) of emergency inflammatory bowel disease (IBD) care in the Covid-19 pandemic. To quantify the reduction in provision of IBD investigations and procedures during the pandemic. Methods: Nationwide observational study using administrative data (Hospital Episode Statistics) for England (2015-2020). Autoregressive integrated moving average (ARIMA) forecast models were run to estimate the counterfactual IBD admissions and procedures for February 2020 onwards had the pandemic not occured. Results: Large decreases in attendances to hospital for emergency treatment were noted for both acute ulcerative colitis (UC) and Crohn's disease (CD) (17.4% and 10.3%). The prevalence of concomitant Sars-CoV- 2 infection during the same episode was low for UC and CD [1.7% (247/14,708) and 1.3% (179/14,126), respectively]. All IBD procedures and investigations showed marked decreases in volume to December 2020 compared to the counterfactual estimates. The largest absolute deficits were in lower gastrointestinal endoscopy (16,223, 35.7% reduction), reversal of ileostomy (2,489, 39.7% reduction) and right sided/ileal resection or strictureplasty for Crohn's disease (879, 12.5% reduction). There were no significant clinical differences in case mix or outcome of emergency admission for IBD in the pandemic compared to a historical cohort. Conclusion: There is likely a significant burden of untreated IBD in the community exacerbated by the pandemic based on reductions in emergency IBD care and IBD procedures undertaken in 2020. Patients with IBD may experience significant clinical harm or a protracted decrease in quality of life if care is not prioritised.