Background & Aims

Patients with Crohn’s disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative 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 an initial surgical date after May 1982. We collected data on the 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 showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery 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. Postoperative 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 bionaive subgroup.

Conclusions

The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.

中文翻译：

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克罗恩病患者再手术率在 2002 年后显着下降

背景与目标

克罗恩病 (CD) 患者可能需要多次肠道手术。我们检查了接受肠道手术的 CD 患者再次手术的时间趋势和危险因素，重点关注术后药物治疗的效果。

方法

我们对 1871 名在日本 10 家三级医疗机构接受初始肠切除术的 CD 患者进行了回顾性分析，初始手术日期在 1982 年 5 月之后。我们收集了所有患者的背景特征数据，包括蒙特利尔分类、吸烟状况、和手术后的药物治疗（肿瘤坏死因子拮抗剂 [抗 TNF] 剂或免疫调节剂）。主要结果是需要第一次再次手术。使用 Kaplan-Meier 方法估计再手术率，使用 Cox 回归模型确定再手术的危险因素。

结果

总体累计 5 年和 10 年再手术率分别为 23.4% 和 48.0%。多变量分析显示，与 2002 年 4 月之前接受手术的患者相比，2002 年 5 月之后接受初次手术的患者的再手术率显着降低（风险比 [HR]，0.72；95% CI，0.61-0.86）。术前吸烟（HR，1.40；95% CI，1.18-1.68），肛周疾病（HR，1.50；95% CI，1.27-1.77）和回结肠型 CD（HR，1.42；95% CI，1.20-1.69）是再次手术的重要危险因素。术后使用免疫调节剂（HR，0.60；95% CI，0.44-0.81）和抗 TNF 治疗（HR，0.71；95% CI，0.57-0.88）显着降低了风险。抗 TNF 在生物初始亚组中有效。

结论

2002 年 5 月后 CD 患者的再手术率显着下降。术后使用抗 TNF 药物可能会降低 CD 生物素患者的再手术率。