Rate of Reoperation Decreased Significantly After Year 2002 in Patients with Crohn’s Disease.
Clin Gastroenterol Hepatol. 2019 Jul 20;:
Authors: Shinagawa T, Hata K, Ikeuchi H, Fukushima K, Futami K, Sugita A, Uchino M, Watanabe K, Higashi D, Kimura H, Araki T, Mizushima T, Itabashi M, Ueda T, Koganei K, Oba K, Ishihara S, Suzuki Y
BACKGROUND & AIMS: Patients with Crohn’s disease (CD) can require multiple intestinal operations. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of post-operative medical treatments.
METHODS: We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with initial operative date after May 1982. We collected data on background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF agents] or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model.
RESULTS: The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis revealed that patients who underwent the initial operation after May 2002 had a significantly lower rate of reoperation than patients who were operated on before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Post-operative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bio-naïve subgroup.
CONCLUSIONS: The rate of reoperation in patients with CD significantly decreased after May 2002. Post-operative use of anti-TNF agents might reduce the reoperation rate for bio-naïve patients with CD.
PMID: 31336198 [PubMed – as supplied by publisher]