Literature DB >> 25331349

Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies.

Alexandra D Frolkis1, Debra S Lipton2, Kirsten M Fiest3, María E Negrón4, Jonathan Dykeman3, Jennifer deBruyn2, Nathalie Jette3, Talia Frolkis2, Ali Rezaie1, Cynthia H Seow1, Remo Panaccione2, Subrata Ghosh2, Gilaad G Kaplan1.   

Abstract

OBJECTIVES: Approximately 50% of Crohn's disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and the influence of time are not well characterized. We performed a systematic review and meta-analysis to establish the risk of second abdominal surgery in patients with Crohn's disease among patients who had a previous surgery.
METHODS: We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn's disease and intestinal surgery. We included population-based articles (n=11) and an abstract (n=1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn's disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time.
RESULTS: For all population-based studies, the overall risk of second surgery was 28.7% (95% confidence interval (CI): 22.6-36.6%). The 5-year risk of second surgery was 24.2% (95% CI: 22.3-26.4%). The 10-year risk of second surgery was 35.0% (95% CI: 31.8-38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2-35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7-52.7%).
CONCLUSIONS: Approximately one-quarter of Crohn's disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.

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Year:  2014        PMID: 25331349     DOI: 10.1038/ajg.2014.297

Source DB:  PubMed          Journal:  Am J Gastroenterol        ISSN: 0002-9270            Impact factor:   10.864


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