The risk of later surgery at the anastomotic site following right hemicolectomy for Crohn’s disease in a national cohort of 12 230 patients

Research output: Contribution to journalArticlepeer-review

Authors

  • Dominic King
  • Benjamin Coupland
  • Amandeep Dosanjh
  • Andrew Cole
  • Nigel Trudgill

Abstract

Background: Crohn’s Disease (CD) has a high-risk of bowel resection and later surgery for recurrent disease. Recent guidelines advocate colonoscopy 6-12 months following surgery to reduce further surgical intervention through medical therapy intensification.

Aims: To investigate the risk of further surgery at the anastomosis following right hemicolectomy for CD.

Methods: Hospital Episode Statistics were used to identify patients with CD and a right hemicolectomy between 2007-2016. Adherence to post-resection colonoscopy guidance timing and risk of further surgery at the anastomosis were examined. Cox proportional hazards models assessed risk factors for further surgery.

Results: 12,230 patients were identified: 45% male; median age 36 (IQR 26-49) years. Median follow-up was 5.9 (IQR3.6-8.6) years: totalling 74,960 person-years. Median time to further surgery was 2.9 (IQR1.2-5.3) years. By 5-years 9%, and 10-years 16.9% of those with sufficient follow-up had at least one further surgery at the anastomotic site. Older, less deprived patients, and those whose index surgery took place on an elective admission were associated with reduced further surgery risk. The annual number of right hemicolectomies increased over the study from 1,063 to 1,317, driven by increasing prevalence of CD. Overall, 78% of patients did not have a colonoscopy, as recommended, within 6-12 months following index resection.

Conclusions: Further surgery at the anastomotic site remains common following index right hemicolectomy for CD. Post-surgical colonoscopy was only undertaken in 22% of patients within suggested timeframes. Increased colonoscopy may lead to a reduced need for surgery if early optimisation of medical therapy is undertaken for recurrence.

Details

Original languageEnglish
Pages (from-to)114-127
Number of pages14
JournalAlimentary Pharmacology & Therapeutics
Volume53
Issue number1
Early online date21 Oct 2020
Publication statusPublished - Jan 2021

Keywords

  • Inflammatory Bowel Disease, Crohn’s Disease, Colectomy, Colonoscopy