Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies

Research output: Contribution to journalReview articlepeer-review


  • Alexandra D Frolkis
  • Debra S Lipton
  • Kirsten M Fiest
  • María E Negrón
  • Jonathan Dykeman
  • Jennifer deBruyn
  • Nathalie Jette
  • Talia Frolkis
  • Ali Rezaie
  • Cynthia H Seow
  • Remo Panaccione
  • Gilaad G Kaplan

Colleges, School and Institutes

External organisations

  • University of Calgary


OBJECTIVES: Approximately 50% of Crohn's disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and the influence of time are not well characterized. We performed a systematic review and meta-analysis to establish the risk of second abdominal surgery in patients with Crohn's disease among patients who had a previous surgery.

METHODS: We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn's disease and intestinal surgery. We included population-based articles (n=11) and an abstract (n=1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn's disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time.

RESULTS: For all population-based studies, the overall risk of second surgery was 28.7% (95% confidence interval (CI): 22.6-36.6%). The 5-year risk of second surgery was 24.2% (95% CI: 22.3-26.4%). The 10-year risk of second surgery was 35.0% (95% CI: 31.8-38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2-35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7-52.7%).

CONCLUSIONS: Approximately one-quarter of Crohn's disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.


Original languageEnglish
Pages (from-to)1739-1748
Number of pages10
JournalThe American Journal of Gastroenterology
Issue number11
Early online date21 Oct 2014
Publication statusPublished - Nov 2014


  • Crohn Disease, Digestive System Surgical Procedures, Humans, Incidence, Reoperation, Risk Factors, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review