Sa1096

Patient or Procedural Factors: What Drives Readmission After Surgery forCrohn's Disease?Jennifer L. Bennett, Christina Y. Ha, Elizabeth Wick

Background: Hospital readmission is associated with increased cost and worse patient out-comes. Readmission has emerged as a surrogate metric of quality. Crohn's disease (CD)patients requiring surgical management are at risk for hospital readmission, which maydelay additional therapies. The aim of this study was to assess readmission rates at a tertiaryIBD referral center and risk factors in post-operative CD patients in order to identify areasto target for improvement. Methods: We performed a cohort study of colorectal surgerypatients captured in the National Surgical Outcome Improvement Program (NSQIP) databasewith the discharge ICD-9 diagnostic code of 555.x (Crohn's disease, CD) between January2009-January 2012. Variables of interest included pre-operative medications, disease behav-ior and phenotype, and pre-operative comorbidities. Primary outcomes of interest were 30-day post-operative readmission and post-operative complications. Results: There were 114Crohn's patients admitted for surgical management of CD over the 3-year period with a30-day readmission rate of 19.2% (n=22). Within this cohort, the 30-day post-operativecomplication rate (medical and/or surgical) was 19.2% (95% CI 10.9-24.7). Disease behavior(p=0.09) and location (p=0.70) were not significantly associated with readmission rates.Post-operative complications were the primary risk factor for readmission with 45.5% ofreadmitted patients experiencing post-operative complications compared to 13.0% amongpatients not requiring readmission (p=0.002). Average length of stay for the index admissionwas longer in readmitted patients compared to those not readmitted (13.9 ± 2.8 vs 8.0 ±0.5 days; p=0.0008). Pre-operative steroid, biologic and immunomodulator use, TPN, weightloss, anemia, prior surgical history, disease duration or emergent surgery were not associatedwith readmission. Conclusions: Readmission after Crohn's disease surgery is primarily drivenby the presence of post-operative complications, not CD location or phenotype. Efforts toreduce 30-day readmissions should focus on early recognition and prevention of post-operative complications. Further study is needed to determine the impact of readmissionon the timeline for resuming CD therapies to prevent early disease recurrence.

Sa1097

Improving Inter-Pathologist Agreement for Serrated Polyps: Do Two NewTactics Work?Jennifer M. Kolb, Shannon J. Morales, Nicholas A. Rouse, Jay Desai, Susan Kornacki,Lawrence B. Cohen, Neville D. Bamji, Kenneth M. Miller, Roy M. Soetikno, TonyaKaltenbach, Robert V. Rouse, James Aisenberg

Purpose: Serrated polyps (SPs) may evolve into colon cancer. Although the histologic distinc-tion between SP sub-types [hyperplastic polyps (HPs) and sessile serrated adenomas (SSAs)]is important, the distinction can be difficult. To address this: (1) modified criteria for SSAdiagnosis have been proposed ; and (2) we have described a novel protocol to improvehistologic section quality. In this modified protocol (MP), resected specimens are flattenedin a paper envelope before they are placed in formalin and processed intact before they aresectioned and embedded in the pathology lab. MP improves polyp orientation comparedto a conventional protocol (CP). Methods: We assessed inter-pathologist agreement for SPusing an archive of 264 proximal colon SPs, resected at two practice locations; and 2 GIand 2 general pathologists working in different practices/centers. We tested the impact ofMP versus CP and WHO versus recently proposed modified consensus criteria; and GIspecialist versus general pathology practice. Polyps were interpreted utilizing three diagnosticcategories: "SSA," "HP," or "Indeterminate." Results were analyzed using the chi-square testfor independence and McNemar's test for paired data. Results: For all 4 pathologists, therewas a trend to improved inter-observer agreement with MP versus CP (44.9% vs. 28.6%,P =0.14). For 2 GI specialist pathologists, inter-observer agreement was better with MPversus CP (77.0% vs. 62.8%, P=0.015). For general pathologists, there was a trend toimproved inter-observer agreement with MP versus CP (69.39% vs. 61.22%, P=0.523).There was a trend to improved inter-observer agreement for modified consensus criteriacompared to WHO criteria (73.5% vs. 63.5%, p=0.099; weighted kappa 0.612 and 0.446respectively). Using modified consensus rather than WHO criteria changed the diagnosisfor 20/196 (10.2%) polyps from HP to SSA. Conclusions: Basic technical modifications inSP handling and modifications in diagnostic criteria can improve inter-observer agreementamongst pathologists. Close collaboration between gastroenterologists and pathologists isessential for improving the efficacy of screening and surveillance colonoscopy 1. Am JGastroenterol 2012; 107(9).1315-29, 2. Morales, S. et al. Abstract submitted to DDW2013 3. World Health Organization., International Agency for Research on Cancer. WHOclassification of tumours of the digestive system. 2010

Sa1098

The Impact of Arthropathies in Inflammatory Bowel Diseases Is Significant:Results From a Longitudinal Analysis in a Multi-Disciplinary IBD ClinicDaniel W. Hommes, Herma Fidder, Andrea E. van der Meulen - de Jong, LianneBrakenhoff

Arthropathies are common extra-intestinal manifestation in inflammatory bowel disease(IBD), their symptoms cause debilitating symptoms. We have established a multi-disciplinaryclinic for patients with IBD related arthropathies with the aim to come to improved classifica-tion and treatment algorithms. Here, we prospectively assessed the effect of patient-reportedfactors on Quality of Life (QoL) in IBD patients with and without arthropathies. Methods:Our cohort consists of 510 IBD patients (321 CD, 186 UC, 3 IBDU). 310 (61%) reportedjoint symptoms: 12% back pain, 54% peripheral joint pain/swelling and 34% both. Ofthese 310 patients, we included 135 patients (77% Crohn's disease (CD), 34% male) witharthropathies (daily back pain for ≥3 months and/or peripheral joint pain and/or jointswelling during the last year) in our longitudinal 12 month study, and 46 patients (74%CD, 50% male) who had no arthropathies served as controls. QoL was assessed by theshortIBDQ and SF-36. Disease activity was assessed using the Harvey-Bradshaw Index (HBI)

S-201 AGA Abstracts

and Simple Clinical Colitis Activity Index (SCCAI). Joint activity and (nocturnal) pain(back and peripheral joints) were scored (11-point numerical rating scale (NRS)). The self-administered questionnaires were assessed every 3-months. Linear mixed model (uni- andmultivariate) analyses were performed to investigate which variables affected QoL. Results:The mean age was 43.6±13.7 yrs and the mean IBD disease duration was 15.6±11.1 yrs.79%of patients with back pain developed symptoms after IBD diagnosis, and most reported painin the lumbar spine (82%). The minority of patients (35%) reported an association betweenonset back pain and IBD activity. CD patients had earlier age at onset and longer durationof peripheral joint complaints compared to UC (both p ,0.05). Pain was monoarticular in20 patients (16%), oligoarticular in 55 (44%) patients and polyarticular in 51 patients (41%).Patients with arthropathies had significantly lower mean sIBDQ scores, compared to IBDpatients without arthropathies, 47.3 and 54.9 (p,0.001). Multivariate analysis showed thatan increase in NRS of activity back joints, an increase in NRS of activity peripheral jointsand activity IBD independently negatively affected shortIBDQ outcome (all p,0.001). Periph-eral joint pain, back pain and IBD activity independently negatively affected the PCS andMCS (all p,0.001). Conclusion: Arthropathies in IBD significantly negatively impact theQoL over extended periods of time. A multidisciplinary care pathway with rheumatologistsand new therapeutic strategies are warranted.

Sa1099

Collection of Patient Centered Outcomes in Esophageal Disease: An OpenSource Web Based FrameworkAndrew J. Gawron, Sherri L. LaVela, David Were, Meghan Thompson, Jordan Swiskow,Peter J. Kahrilas, Warren A. Kibbe, John E. Pandolfino

Background: Esophageal disorders have a significant effect on psychological well-being andquality of life. Management of these patients should involve a patient centered approachusing valid patient reported outcome measures to evaluate the effectiveness of diagnosticand treatment strategies. Many practice settings are not equipped with systems to routinelycollect patient-reported outcomes during routine clinical care. Objective: The aims were toevaluate the effectiveness, usability, and satisfaction of collecting electronic patient reportedoutcomes (ePROs) in patients with esophageal complaints using a novel web framework(eNOTIS) and iPad™ tablets. Methods: eNOTIS is an open source web-based study enroll-ment log that meets FDA electronic reporting guidelines. We modified eNOTIS to collectePROs with iPad™ tablets in patients referred for esophageal complaints (dysphagia and/or reflux symptoms) from 8/2011-8/2012. Patients completed 10 ePRO measures duringclinic visits (121 total questions). Five ePRO measures were disease specific (e.g. GerdQ,Visceral Sensitivity Index) and five were not disease specific (e.g. Anxiety Sensitivity Index,Perceived Stress Scale). The time (min) burden to complete each ePRO was measured.Usability and satisfaction of using eNOTIS with iPads™ was measured in a sample (20%)of patients with a modified version of a previously developed survey. Results: A total of 482patients were recruited of which 431 completed ePRO measures (89.4%). More patientswere female (52.2%) and white/non-hispanic (84.7% and 93.7%); the mean age was 48.3yrs (sd 15.3). The primary complaints were reflux symptoms (N=217, 50.4%) and dysphagia(N=208, 48.3%). Figure 1 shows the total patient enrollment and a sample ePRO collectedvia eNOTIS. The median time to complete each individual questionnaire ranged from aminimum of 0.8 min (IQR 0.8) for the Perceived Stress Scale (N=4 items) to a maximumof 1.9 min (IQR 2.0) for the Visceral Sensitivity Index (N=15 items). Of 93 patients surveyed,83 (89.2%) reported usability "very easy" or "somewhat easy." Most patients were "verysatisfied" (67.7%) or "satisfied" (23.7%) in reporting symptoms and would recommend theeNOTIS/iPad™ framework to other patients (95.7%). A substantial proportion of patientsreported the system helped them remember symptoms (46.2%) and encouraged them todiscuss medical issues with their doctor (35.5%) (Table1). Conclusions: We successfullyintegrated a web-based system for rapid collection of patient reported outcomes duringclinical care. This framework has demonstrated usability, requires minimal time, and mayimprove patient recall and discussion. The open source framework could be adopted acrossinstitutions and practice settings to incorporate patient-reported outcome measures in gastro-enterology clinical practice and research.Table 1: Effect of eNOTIS and iPADTM tablets on recall and discussion of medical issues

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