Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease

Shinagawa, Takahiro; Hata, Keisuke; Ikeuchi, Hiroki; Fukushima, Kouhei; Futami, Kitaro; Sugita, Akira; Uchino, Motoi; Watanabe, Kazuhiro; Higashi, Daijiro; Kimura, Hideaki; Araki, Toshimitsu; Mizushima, Tsunekazu; Itabashi, Michio; Ueda, Takeshi; Koganei, Kazutaka; Oba, Koji; Ishihara, Soichiro; Suzuki, Yasuo

doi:10.1016/j.cgh.2019.07.025

Cited by 28 publications

(39 citation statements)

References 27 publications

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“…Furthermore, we found that the cumulative 5- and 10-year reoperation rates were 29.4% and 43.9%, respectively. These results are in line with those found in the literature for CD ( 7 – 9 , 18 , 21 ). We did not analyze the cumulative reoperation rate for patients with UC because we were not able to consider multistage procedures and thus overestimating the cumulative reoperation rate.…”

Section: Discussionsupporting

confidence: 93%

“…However, we observed a 1.7-fold decrease in the reoperation rate by adjusting the reoperation numbers for the forecasted population of patients with IBD (Figure 1 c and Supplementary Figure 1b, Supplementary Digital Content 1, http://links.lww.com/CTG/A392 ). This decrease of adjusted reoperation rates among patients with IBD that has also been evidenced recently by other authors in distinct geographic zones ( 4 , 5 , 7 , 17 , 18 , 21 ) might be explained by a combination of 2 factors: (i) the increasing prevalence of IBD in Portugal (and globally) ( 3 , 5 ) and (ii) the approval of novel biologic treatments ( 22 ). These results evidence that the analysis of reoperation rates can only be conclusive and realistic when performed in a broad perspective considering total population, hospitalizations, and disease prevalence.…”

Section: Discussionsupporting

confidence: 72%

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Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence

Santiago

Magro²,

Correia

et al. 2020

Clinical and Translational Gastroenterology

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INTRODUCTION: Despite the recent emergence of expensive biologic therapies, hospitalization and surgery remain important contributors for the overall costs of inflammatory bowel disease (IBD). In this study, we aimed to describe the burden of reoperations in patients with IBD by evaluating reoperation rates, charges, and risk factors over 16 years. METHODS: We performed a retrospective analysis of all hospital discharges, with focus on reoperations and with a primary diagnosis of IBD, in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System's national registry. We collected data on patient, clinical, and healthcare charges. We used multivariate regressions to estimate the risk factors of IBD-related reoperations. RESULTS: We found that 5% of IBD-related hospitalizations were related to reoperations. The number of reoperations per year increased by approximately 200%. However, when corrected by the prevalence of the disease, IBD reoperation rates decreased. Mean IBD-related charges per hospitalization were 7,780 € in 2000 and 10,592 € in 2015, with total charges reaching 6.7 million euros by the end of the study. Risk factors for reoperation include urgent hospitalization, in patients with ulcerative colitis (odds ratio 1.94, 95% confidence interval 1.19–3.17, P = 0.008), and colic disease, in patients with Crohn's disease (odds ratio 1.57, 95% confidence interval 1.06–2.34, P = 0.025). DISCUSSION: To obtain an accurate scenario of reoperations among patients with IBD, it is mandatory to adjust the number of reoperations to the prevalence of the disease. Reoperation and its risk factors should be closely monitored to decrease the burden of IBD to the healthcare system.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 72%

Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence

Santiago

Magro²,

Correia

et al. 2020

Clinical and Translational Gastroenterology

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“…Although medical treatment has advanced, a large proportion of patients will still require surgery. 15,16 One of the strengths of the present paper is that it reports on a locality where the realities for such patients were unknown.…”

Section: Discussionmentioning

confidence: 92%

Epidemiological profile of inflammatory bowel disease in Caxias do Sul, Brazil: a cross-sectional study

et al. 2020

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“…In particular, anti‐TNFα could dramatically change the treatment strategy for CD. However, it is yet unclear whether the early use of anti‐TNFα could improve the natural history of CD, even though the annual surgical rates tend to decrease worldwide . There is also controversy regarding whether anti‐TNFα therapy, particularly infliximab, would result in intestinal stricture progression.…”

Section: Introductionmentioning

confidence: 87%

Optimal use of biologics with endoscopic balloon dilatation for repeated intestinal strictures in Crohn's disease

et al. 2020

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Background and Aim Intestinal strictures in Crohn's disease (CD) have a high rate of repeated surgery. As alternatives to surgery, endoscopic balloon dilatation (EBD), immunomodulators (IMs), and antitumor necrosis factor alpha (anti‐TNFα) have been proposed. We aimed to assess the effectiveness of the combined therapy with anti‐TNFα and EBD in preventing intestinal stricture recurrence and surgery in patients with CD. Methods This retrospective cohort study included patients from the nationwide administrative database in Japan who were hospitalized and underwent at least one EBD between 1 April 2010 and 31 March 2017. The effectiveness of anti‐TNFα was evaluated by performing survival analysis for the primary outcome. We selected the inverse probability of treatment weighting method for adjustment of covariates. As an exploratory analysis, we evaluated the association of anti‐TNFα initiation timing with intestinal stricture recurrence. Results The anti‐TNFα exposed group had a significantly lower risk of intestinal stricture recurrence than that of the anti‐TNFα nonexposed group (hazard ratio = 0.38, 95% confidence interval 0.31–0.48, P < 0.001). Surgery‐free rate was shown to have the same tendency. Anti‐TNFα therapy initiation before or after EBD resulted in a lower risk of intestinal stricture recurrence than that of simultaneous treatment. Conclusion The combined therapy with anti‐TNFα and EBD could have preventive effects for intestinal stricture recurrence and surgery in hospitalized patients with CD. In particular, anti‐TNFα initiation may be recommended before or after EBD, not immediately after EBD. With respect to EBD, it is important to clarify the effectiveness of combination therapy with several new medication treatments, such as biologics.

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Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease

Cited by 28 publications

References 27 publications

Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence

Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence

Epidemiological profile of inflammatory bowel disease in Caxias do Sul, Brazil: a cross-sectional study

Optimal use of biologics with endoscopic balloon dilatation for repeated intestinal strictures in Crohn's disease

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