Crohn's disease after surgery: Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study.
Aliment Pharmacol Ther
; 59(12): 1579-1588, 2024 06.
Article
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| MEDLINE
| ID: mdl-38616417
ABSTRACT
BACKGROUND:
Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course.AIM:
To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD.METHODS:
We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation.RESULTS:
Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively.CONCLUSION:
Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Reoperación
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Enfermedad de Crohn
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2024
Tipo del documento:
Article