Decrease in primary but not in secondary abdominal surgery for Crohn's disease: nationwide cohort study, 1990–2014

Abstract

Background Treatment of patients with Crohn's disease has evolved in recent decades, with increasing use of immunomodulatory medication since 1990 and biologicals since 1998. In parallel, there has been increased use of active disease monitoring. To what extent these changes have influenced the incidence of primary and repeat surgical resection remains debated. Methods In this nationwide cohort study, incident patients of all ages with Crohn's disease, identified in Swedish National Patient Registry between 1990 and 2014, were divided into five calendar periods of diagnosis: 1990–1995 and 1996–2000 with use of inpatient registries, 2001, and 2002–2008 and 2009–2014 with use of inpatient and outpatient registries. The cumulative incidence of first and repeat abdominal surgery (except closure of stomas), by category of surgical procedure, was estimated using the Kaplan–Meier method. Results Among 21 273 patients with Crohn's disease, the cumulative incidence of first abdominal surgery within 5 years of Crohn's disease diagnosis decreased continuously from 54·8 per cent in 1990–1995 to 40·4 per cent in 1996–2000 (P < 0·001), and again from 19·8 per cent in 2002–2008 to 17·3 per cent in 2009–2014 (P < 0·001). Repeat 5‐year surgery rates decreased from 18·9 per cent in 1990–1995 to 16·0 per cent in 1996–2000 (P = 0·009). After 2000, no further significant decreases were observed. Conclusion The 5‐year rate of surgical intervention for Crohn's disease has decreased significantly, but the rate of repeat surgery has remained stable despite the introduction of biological therapy.

Surgery and stomas in Crohn's disease

“…Biologicals do not seem to have affected incidence of repeat surgery after a first decrease in the 90s and a plausible explanation for this could be that the patients that still do get selected to surgery have a more aggressive disease refractory to medication. Our data however shows a lower risk of repeat surgery than earlier reports with only 8.8% now needing an ileocolic reresection after 10 years and in total 24% of all patients having a surgical recurrence after 10 years 302 . This information is of importance to doctors when discussing prognosis and making therapeutic decisions with the patients and for evaluation of effects of future treatment regimens.…”

“…With a nationwide cohort with a high validity of diagnostic and procedural coding we have reliable data showing a continuing decrease in primary abdominal surgery for CD throughout the period 1990-2014 302 . This decrease started during the 90s when more frequent use of IMM was implemented and has continued into the biologic era.…”

Impaired Fertility in Women With Inflammatory Bowel Disease: A National Cohort Study From Sweden

“…However, this factor does not appear to have been of any significance in previous studies. 31 For CD patients, fertility remained impaired throughout.…”

Women’s Earnings are more Affected by Inflammatory Bowel Disease than Men’s: A Register-Based Swedish Cohort Study

“…Inflammatory bowel disease [IBD], comprising Crohn’s disease, ulcerative colitis and IBD unclassified, has peak incidence in working-age individuals. 1 Due to its chronic and relapsing nature with periods of debilitating symptoms, need for regular physician visits, 2 and sometimes medical or surgical treatments in the hospital, 3 , 4 the disease has the potential to affect an individual’s lifelong economic situation. For society, IBD is associated with high costs, both direct medical costs and indirect costs from productivity losses.…”