Crohn's disease after surgery : Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study
© 2024 John Wiley & Sons Ltd..
BACKGROUND: Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course.
AIM: To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD.
METHODS: We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation.
RESULTS: Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively.
CONCLUSION: Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Alimentary pharmacology & therapeutics - (2024) vom: 14. Apr. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Aratari, Annalisa [VerfasserIn] |
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Date Revised 15.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1111/apt.18001 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM371057396 |
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| 100 | 1 | |a Aratari, Annalisa |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Crohn's disease after surgery |b Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 15.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 John Wiley & Sons Ltd. | ||
| 520 | |a BACKGROUND: Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course | ||
| 520 | |a AIM: To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD | ||
| 520 | |a METHODS: We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation | ||
| 520 | |a RESULTS: Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively | ||
| 520 | |a CONCLUSION: Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Scribano, Maria Lia |e verfasserin |4 aut | |
| 700 | 1 | |a Pugliese, Daniela |e verfasserin |4 aut | |
| 700 | 1 | |a Baccolini, Valentina |e verfasserin |4 aut | |
| 700 | 1 | |a De Biasio, Fabiola |e verfasserin |4 aut | |
| 700 | 1 | |a Verna, Serena |e verfasserin |4 aut | |
| 700 | 1 | |a Morretta, Chiara |e verfasserin |4 aut | |
| 700 | 1 | |a Festa, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Armuzzi, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Papi, Claudio |e verfasserin |4 aut | |
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