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

Annalisa Aratari; Maria Lia Scribano; Daniela Pugliese; Valentina Baccolini; Fabiola De Biasio; Serena Verna; Chiara Morretta; Stefano Festa; Alessandro Armuzzi; Claudio Papi

doi:10.1111/apt.18001

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. 2024 Apr 14. doi: 10.1111/apt.18001. Online ahead of print.

Authors

Affiliations

¹ IBD Unit, San Filippo Neri Hospital, Rome, Italy.
² Gastroenterology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
³ IBD Unit, Digestive Disease Center (CEMAD) Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
⁴ Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
⁵ IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁶ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

PMID: 38616417
DOI: 10.1111/apt.18001

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.