The risk of subsequent surgery following bowel resection for Crohn’s disease in a national cohort of 19,207 patients

Dominic King; Benjamin  Coupland; Amandeep Dosanjh; Andrew Cole; Stephen Ward; Raoul Reulen; Nicola Adderley; Prashant Patel; Nigel Trudgill

doi:10.1111/codi.16331

The risk of subsequent surgery following bowel resection for Crohn’s disease in a national cohort of 19,207 patients

Dominic King, Benjamin Coupland, Amandeep Dosanjh, Andrew Cole, Stephen Ward, Raoul Reulen, Nicola Adderley, Prashant Patel, Nigel Trudgill^*

^*Corresponding author for this work

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Abstract

Background and Aims: Surgery is required for most patients with Crohn’s disease (CD) and further surgery may be necessary if medical treatment fails to control disease activity. The aim of this study was to characterize the risk of, and factors associated with further surgery, following a first resection for Crohn’s disease.

Methods: Hospital Episode Statistics from England were examined to identify patients with CD and a first recorded bowel resection between 2007 and 2016. Multivariable logistic regression was used to examine risk factors for further resectional surgery within 5-years. Prevalence-adjusted surgical rates for index CD surgery over the study period were calculated.

Results: 19,207 patients (median age 39 (IQR 27-53) years and 55% female) with CD underwent a first recorded resection during the study period. 3,141 (16%) underwent a further operation during the study period. The median time to further surgery was 2.4 (IQR 1.2-4.6) years. 3% of CD patients had further surgery within one year, 14% by 5 years and 23% by 10 years. Older age (≥58), index laparoscopic surgery and index elective surgery (adjusted odds ratios 0.65 (95% CI 0.54-0.77), 0.77 (0.67-0.88), 0.63 (0.53-0.73), and 0.77 (0.69-0.85), respectively) were associated with a reduced risk of further surgery by 5-years. Prior surgery for perianal disease (1.60 (1.37-1.87)), an extraintestinal manifestation (EIM) of CD (1.51 (1.22-1.86)) and index surgery in a high-volume centre for CD surgery (1.20 (1.02-1.40)) were associated with an increased risk of further surgery by 5-years. A 25% relative and 0.3% absolute reduction in prevalence-adjusted index surgery rates for CD was observed over the study period.

Conclusions: Further surgery following an index operation is common in CD. This risk was particularly seen in patients with perianal disease, EIMs and those who underwent index surgery in a high-volume centre.

Original language	English
Journal	Colorectal Disease
Early online date	13 Sept 2022
DOIs	https://doi.org/10.1111/codi.16331
Publication status	E-pub ahead of print - 13 Sept 2022

Keywords

Crohn’s Disease
Inflammatory Bowel Disease
colectomy
extraintestinal manifestations of Inflammatory Bowel Disease
perianal disease
surgery

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Cite this

@article{5ff571fd08104abf9e4129666ec2054c,

title = "The risk of subsequent surgery following bowel resection for Crohn{\textquoteright}s disease in a national cohort of 19,207 patients",

abstract = "Background and Aims: Surgery is required for most patients with Crohn{\textquoteright}s disease (CD) and further surgery may be necessary if medical treatment fails to control disease activity. The aim of this study was to characterize the risk of, and factors associated with further surgery, following a first resection for Crohn{\textquoteright}s disease.Methods: Hospital Episode Statistics from England were examined to identify patients with CD and a first recorded bowel resection between 2007 and 2016. Multivariable logistic regression was used to examine risk factors for further resectional surgery within 5-years. Prevalence-adjusted surgical rates for index CD surgery over the study period were calculated.Results: 19,207 patients (median age 39 (IQR 27-53) years and 55% female) with CD underwent a first recorded resection during the study period. 3,141 (16%) underwent a further operation during the study period. The median time to further surgery was 2.4 (IQR 1.2-4.6) years. 3% of CD patients had further surgery within one year, 14% by 5 years and 23% by 10 years. Older age (≥58), index laparoscopic surgery and index elective surgery (adjusted odds ratios 0.65 (95% CI 0.54-0.77), 0.77 (0.67-0.88), 0.63 (0.53-0.73), and 0.77 (0.69-0.85), respectively) were associated with a reduced risk of further surgery by 5-years. Prior surgery for perianal disease (1.60 (1.37-1.87)), an extraintestinal manifestation (EIM) of CD (1.51 (1.22-1.86)) and index surgery in a high-volume centre for CD surgery (1.20 (1.02-1.40)) were associated with an increased risk of further surgery by 5-years. A 25% relative and 0.3% absolute reduction in prevalence-adjusted index surgery rates for CD was observed over the study period.Conclusions: Further surgery following an index operation is common in CD. This risk was particularly seen in patients with perianal disease, EIMs and those who underwent index surgery in a high-volume centre.",

keywords = "Crohn{\textquoteright}s Disease, Inflammatory Bowel Disease, colectomy, extraintestinal manifestations of Inflammatory Bowel Disease, perianal disease, surgery",

author = "Dominic King and Benjamin Coupland and Amandeep Dosanjh and Andrew Cole and Stephen Ward and Raoul Reulen and Nicola Adderley and Prashant Patel and Nigel Trudgill",

year = "2022",

month = sep,

day = "13",

doi = "10.1111/codi.16331",

language = "English",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "Wiley",

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TY - JOUR

T1 - The risk of subsequent surgery following bowel resection for Crohn’s disease in a national cohort of 19,207 patients

AU - King, Dominic

AU - Coupland, Benjamin

AU - Dosanjh, Amandeep

AU - Cole, Andrew

AU - Ward, Stephen

AU - Reulen, Raoul

AU - Adderley, Nicola

AU - Patel, Prashant

AU - Trudgill, Nigel

PY - 2022/9/13

Y1 - 2022/9/13

N2 - Background and Aims: Surgery is required for most patients with Crohn’s disease (CD) and further surgery may be necessary if medical treatment fails to control disease activity. The aim of this study was to characterize the risk of, and factors associated with further surgery, following a first resection for Crohn’s disease.Methods: Hospital Episode Statistics from England were examined to identify patients with CD and a first recorded bowel resection between 2007 and 2016. Multivariable logistic regression was used to examine risk factors for further resectional surgery within 5-years. Prevalence-adjusted surgical rates for index CD surgery over the study period were calculated.Results: 19,207 patients (median age 39 (IQR 27-53) years and 55% female) with CD underwent a first recorded resection during the study period. 3,141 (16%) underwent a further operation during the study period. The median time to further surgery was 2.4 (IQR 1.2-4.6) years. 3% of CD patients had further surgery within one year, 14% by 5 years and 23% by 10 years. Older age (≥58), index laparoscopic surgery and index elective surgery (adjusted odds ratios 0.65 (95% CI 0.54-0.77), 0.77 (0.67-0.88), 0.63 (0.53-0.73), and 0.77 (0.69-0.85), respectively) were associated with a reduced risk of further surgery by 5-years. Prior surgery for perianal disease (1.60 (1.37-1.87)), an extraintestinal manifestation (EIM) of CD (1.51 (1.22-1.86)) and index surgery in a high-volume centre for CD surgery (1.20 (1.02-1.40)) were associated with an increased risk of further surgery by 5-years. A 25% relative and 0.3% absolute reduction in prevalence-adjusted index surgery rates for CD was observed over the study period.Conclusions: Further surgery following an index operation is common in CD. This risk was particularly seen in patients with perianal disease, EIMs and those who underwent index surgery in a high-volume centre.

AB - Background and Aims: Surgery is required for most patients with Crohn’s disease (CD) and further surgery may be necessary if medical treatment fails to control disease activity. The aim of this study was to characterize the risk of, and factors associated with further surgery, following a first resection for Crohn’s disease.Methods: Hospital Episode Statistics from England were examined to identify patients with CD and a first recorded bowel resection between 2007 and 2016. Multivariable logistic regression was used to examine risk factors for further resectional surgery within 5-years. Prevalence-adjusted surgical rates for index CD surgery over the study period were calculated.Results: 19,207 patients (median age 39 (IQR 27-53) years and 55% female) with CD underwent a first recorded resection during the study period. 3,141 (16%) underwent a further operation during the study period. The median time to further surgery was 2.4 (IQR 1.2-4.6) years. 3% of CD patients had further surgery within one year, 14% by 5 years and 23% by 10 years. Older age (≥58), index laparoscopic surgery and index elective surgery (adjusted odds ratios 0.65 (95% CI 0.54-0.77), 0.77 (0.67-0.88), 0.63 (0.53-0.73), and 0.77 (0.69-0.85), respectively) were associated with a reduced risk of further surgery by 5-years. Prior surgery for perianal disease (1.60 (1.37-1.87)), an extraintestinal manifestation (EIM) of CD (1.51 (1.22-1.86)) and index surgery in a high-volume centre for CD surgery (1.20 (1.02-1.40)) were associated with an increased risk of further surgery by 5-years. A 25% relative and 0.3% absolute reduction in prevalence-adjusted index surgery rates for CD was observed over the study period.Conclusions: Further surgery following an index operation is common in CD. This risk was particularly seen in patients with perianal disease, EIMs and those who underwent index surgery in a high-volume centre.

KW - Crohn’s Disease

KW - Inflammatory Bowel Disease

KW - colectomy

KW - extraintestinal manifestations of Inflammatory Bowel Disease

KW - perianal disease

KW - surgery

UR - http://www.scopus.com/inward/record.url?scp=85139402000&partnerID=8YFLogxK

U2 - 10.1111/codi.16331

DO - 10.1111/codi.16331

M3 - Article

SN - 1462-8910

JO - Colorectal Disease

JF - Colorectal Disease

ER -

The risk of subsequent surgery following bowel resection for Crohn’s disease in a national cohort of 19,207 patients

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Keywords

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