T D Kalman1, Å H Everhov2,3, C Nordenvall4,5, M C Sachs3, J Halfvarson6, A Ekbom3, J F Ludvigsson7,8,9,10, P Myrelid1, O Olén2,3,11. 1. Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University, Department of Surgery, County Council of Östergötland, Linköping, Sweden. 2. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden. 3. Division of Clinical Epidemiology, Department of Medicine Solna, Stockholm, Sweden. 4. Department of Molecular Medicine and Surgery, Stockholm, Sweden. 5. Centre for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 7. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. 8. Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden. 9. Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK. 10. Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA. 11. Department of Paediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden.
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.
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.
Authors: N Horesh; M R Freund; Z Garoufalia; R Gefen; D Zhang; T Smith; S H Emile; S D Wexner Journal: Tech Coloproctol Date: 2022-09-29 Impact factor: 3.699
Authors: Åsa H Everhov; Thordis Disa Kalman; Jonas Söderling; Caroline Nordenvall; Jonas Halfvarson; Anders Ekbom; Jonas F Ludvigsson; Ola Olén; Pär Myrelid Journal: Inflamm Bowel Dis Date: 2022-08-01 Impact factor: 7.290
Authors: Michael Eberhardson; Pär Myrelid; Jonas K Söderling; Anders Ekbom; Åsa H Everhov; Charlotte R H Hedin; Martin Neovius; Jonas F Ludvigsson; Ola Olén Journal: Colorectal Dis Date: 2022-01-22 Impact factor: 3.917
Authors: Åsa H Everhov; Gustaf Bruze; Jonas Söderling; Johan Askling; Jonas Halfvarson; Karin Westberg; Petter Malmborg; Caroline Nordenvall; Jonas F Ludvigsson; Ola Olén Journal: J Crohns Colitis Date: 2021-06-22 Impact factor: 9.071