ORIGINAL ARTICLE Colectomy Subtypes, Follow-up Surgical Procedures, Postsurgical Complications, and Medical Charges Among Ulcerative Colitis Patients with Private Health Insurance in the United States Edward V. Loftus, Jr., MD,* Howard S. Friedman, PhD, † David J. Delgado, PhD, ‡ and William J. Sandborn, MD* 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 of 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 proctoco- lectomy (TPC) with ileal pouch–anal anastomosis (IPAA), 2) sub- total 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 complica- tions were collected. We developed estimates for UC-related charges for hospitalizations, outpatient visits, and medications for 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 at least 180 days of pre- and postcolectomy 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 proce- dures, identified several complications postcolectomy, and estimated substantial charges 6 months pre- and postcolectomy. (Inflamm Bowel Dis 2009;15:566 –575) Key Words: ulcerative colitis, colectomy, ileal pouch-anal anasto- mosis, morbidity, complications, direct medical charges U lcerative colitis (UC), a chronic disease often affecting younger populations, is associated with long-term mor- bidity and substantial health care resource utilization. In the United States there was a 48% increase in hospital stays for regional enteritis and UC between 1994 and 2004 according to the Healthcare Cost and Utilization Project (HCUP) spon- sored by the Agency for Healthcare Research and Quality. 1 HCUP estimated that aggregate in-hospital costs for enteritis and UC totaled $821 million in 2004. 1 Increased prevalence, rates of colectomy, utilization of restorative surgical proce- dures, and related complications may help explain this trend. In Olmsted County, Minnesota, the prevalence of UC increased by 21% between 2001 and 2005. 2 The age- and sex-adjusted prevalence of UC on January 1, 2005 was 273 cases per 100,000 persons. 2 Extrapolating this prevalence to the estimated 2008 US population of 303.6 million suggests that there are 829,000 people with treated and untreated UC in the US. Compounding this trend is a shift in distribution of UC extent—in Copenhagen County, the prevalence of exten- sive colitis or pancolitis increased from 18% to 27% over a 4-decade period, 3 and in Olmsted County the prevalence of extensive colitis increased from 38% in 1940 –1960 to 52% in 1981–2000. 4 Many UC patients eventually require surgery during their disease course 5,6 and the cumulative probability of sur- gery may be increasing over time. 7 In Olmsted County the 5-year cumulative risk of colectomy increased from 14% in 1990s to 24% in the 2000 –2004 period. 7 Two other popula- Additional Supporting Information may be found in the online version of this article. Received for publication September 28, 2008; Accepted October 6, 2008. From the *Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota, † Analytic Solutions, LLC, New York, New York, ‡ DJD Health Consulting, Inc, Wayne, Pennsylvania. Supported by a grant from Schering-Plough. Drs. Loftus and Sandborn have received research support from Schering-Plough. Dr. Sandborn has served as a consultant for Schering-Plough and has participated in continuing medical education events indirectly sponsored by Schering-Plough. Drs. Delgado and Friedman are paid consultants for Schering-Plough. Reprints: Edward V. Loftus, Jr., MD, Division of Gastroenterology & Hepatology, Mayo Clinic, 200 First St., S.W., Rochester, MN 55905 (e-mail: loftus.edward@mayo.edu). Copyright © 2008 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.20810 Published online 13 January 2008 in Wiley InterScience (www. interscience.wiley.com). 566 Inflamm Bowel Dis ● Volume 15, Number 4, April 2009