Epidemiology of Acute Colonic Pseudo-obstruction (Ogilvie Syndrome) Based on Disease-Specific Data.

PURPOSE: Prior epidemiologic assessment of acute colonic pseudo-obstruction (ACPO) used nonspecific ICD-9 coding preventing precise case identification. Implementation of disease-specific ICD-10-CM code K59.81 (Ogilvie syndrome) in 2020 enables more accurate characterization.

METHODS

Adults with ICD-10-CM code K59.81 in the 2021-2022 National Inpatient Sample were identified. Patients were classified into four treatment groups: medical management, colonoscopy alone, surgery alone, and combined colonoscopy/surgery. Multivariable regression models assessed associations between treatment group and outcomes.

RESULTS

Age/sex adjusted incidences of ACPO hospitalization were 3.99 and 4.03 per 100,000 population in 2021 and 2022. Incidence was higher in males than females (66% of cases were in men) and increased with age in both sexes. Medical management was the predominant treatment (77.9%), followed by colonoscopy alone (13.0%), surgery alone (6.6%), and combined colonoscopy/surgery (2.4%). Complication and mortality rates were 4.9% and 6.8%. In adjusted analyses, compared to medical management, surgery (OR = 11.48; 95% CI 7.45-17.71) and combined colonoscopy/surgery (OR = 10.41; 95% CI 5.49-19.73) had higher complications, surgery alone had higher mortality (OR = 2.51; 95% CI 1.87-3.37), colonoscopy alone trended toward lower mortality (OR = 0.67; 95% CI 0.45-1.00), and all procedural interventions had longer hospital stays.

CONCLUSIONS

Disease-specific diagnostic coding for ACPO identified a population with pronounced male predominance and higher incidence in the elderly. Colonoscopy was used in 15% of cases and surgery in 9%. While most patients with ACPO require only medical management, colonoscopy was not associated with increased complications and potentially may be associated with reduced mortality. Surgery had the highest complication and mortality rates, likely reflecting greater disease severity in patients requiring operative intervention in addition to the risks of surgery.