Decreasing Risk of First and Subsequent Surgeries in Patients With Crohn's Disease in England From 1994 through 2013
Decreasing Risk of First and Subsequent Surgeries in Patients With Crohn's Disease in England From 1994 through 2013
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DOI：
10.1016/j.cgh.2018.12.022
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发表时间：
2019-09-01
影响因子：
12.6
通讯作者：
Subramanian, Venkataraman
中科院分区：
文献类型：
--
作者：
Burr, Nicholas E.;Lord, Richard;Subramanian, Venkataraman
背景与目的：胃肠道（GI）手术是克罗恩病（CD）患者治疗方案的重要组成部分，这些患者病情复杂或对药物治疗无反应。来自丹麦和加拿大的队列研究表明，初次手术的风险正在降低，但缺乏随后切除的当代数据。我们研究了CD患者第一次和第二次胃肠道切除术的趋势。方法：我们使用英国初级保健数据库ResearchOne进行了一项回顾性队列研究，收集了1994年至2013年克罗恩病患者的数据。我们比较了第一次和第二次胃肠道切除术的发病率与病因factors.RESULTS：在3059例CD，13%，21%和26%的患者进行手术切除后，1，5和10年，分别。在初次切除的患者中，20%在初次切除后随访10年时需要额外手术。我们发现，从1994年到2003年，首次手术率显著下降，从患病10年后的44%下降到21%（趋势卡方，P <0.05）。在10年的随访期内，第二次切除率显著降低，从1994年的40%降至2003年的17%（趋势卡方，P <0.05）。病程、诊断时年龄、吸烟和免疫调节剂的使用与首次手术呈正相关。疾病的持续时间显着相关的风险进行第二次surgery. CONCLUSIONS：在一项回顾性分析英国初级保健数据库，我们观察到一个显着减少在第一次和随后的胃肠道手术的患者CD在过去的20年中在英格兰。
BACKGROUND & AIMS: Gastrointestinal (GI) surgery is an important part of the treatment algorithm for patients with Crohn's disease (CD) that is complicated or does not respond to medical therapy. Cohort studies from Denmark and Canada have shown that the risk of primary surgery is decreasing but there is a lack of contemporary data on subsequent resections. We examined trends in first and second GI resections in patients with CD.METHODS: We performed a retrospective cohort study using the United Kingdom primary care database ResearchOne, collecting data from patients with Crohn's disease from 1994 through 2013. We compared rates of first and second GI resections with etiological factors.RESULTS: Among 3059 incident cases of CD, 13%, 21%, and 26% of the patients underwent surgical resections after 1, 5, and 10 years, respectively. Of patients with an initial resection, 20% required an additional operation when followed for 10 years after the initial resection. We found a significant reduction in first surgery, from 44% to 21% after 10 years of disease, from 1994 to 2003 (chi(2) for trend, P < .05). There was a significant reduction in second resections, in a 10-year follow-up period, from 40% in 1994 to 17% in 2003 (chi(2) for trend, P < .05). Duration of disease, younger age at diagnosis, smoking, and immunomodulator use were positively associated with first surgeries. Duration of disease was significantly associated with the risk of undergoing a second resection.CONCLUSIONS: In a retrospective analysis of a United Kingdom primary care database, we observed a significant reduction in first and subsequent GI surgeries among patients with CD over the past 20 years in England.