Incidence Rates for Surgery in Crohn's Disease Have Decreased: A Population-based Time-trend Analysis.
Incidence Rates for Surgery in Crohn's Disease Have Decreased: A Population-based Time-trend Analysis.
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DOI：
10.1093/ibd/izz315
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发表时间：
2020-11-19
影响因子：
4.9
通讯作者：
Kroeker, Karen I
中科院分区：
文献类型：
--
作者：
Dittrich, Alexandra E;Sutton, Reed Taylor;Kroeker, Karen I
背景：许多克罗恩病（CD）患者在其一生中都会接受手术。人们认为，随着抗肿瘤坏死因子治疗等疾病修饰剂的引入，手术需求的人口水平将下降。这项时间趋势研究旨在评估手术率的变化后，诱导抗TNF therapy.METHODS：成人CD患者进行腹部手术（确定的行政编码）之间的1996年1月和2013年12月在埃德蒙顿地区的4家医院之一。手动审查患者图表以确认诊断并收集人口统计学和疾病相关数据。通过手术数量除以埃德蒙顿CD患者总人群的估计值，计算IBD手术的人群校正年发病率。进行时间趋势分析，以确定变化点，计算每年的百分比变化（APC），以及相关的95%置信区间（CIs）。结果：共1410例克罗恩病患者接受手术治疗。手术率每年下降8.4%（95% CI，-9.6%至7.3%）。每年抗TNF治疗的使用增加了36.2%（95% CI，31.3%至41.5%）。手术的可改变风险因素也发生了变化，包括每年减少2.2%的主动吸烟者比例（95% CI，-3.7%至-0.6%）。虽然抗TNF治疗似乎发挥了作用，但手术趋势的下降可能是多因素的，由于吸烟趋势的下降，早期诊断，早期治疗，改善患者教育，和临床实践的变化。
BACKGROUND: Many Crohn's disease (CD) patients will undergo surgery over the course of their life. It is thought that with the introduction of disease-modifying agents like anti-TNF therapy, there would be a population-level decrease in the need for surgery. This time-trend study aimed to assess the changes in surgical rates following the induction of anti-TNF therapy.METHODS: Adult CD patients who underwent abdominal surgery (identified by administrative coding) between January of 1996 and December of 2013 at 1 of the 4 Edmonton-area hospitals were included. Patient charts were manually reviewed to confirm diagnosis and gather demographic and disease-related data. Population-adjusted annual incidence rates for IBD surgery were calculated by dividing the number of surgeries by estimates for total population of CD patients in Edmonton. Time-trend analysis was conducted to identify change points, calculate annual percent change (APC), and associated 95% confidence intervals (CIs).RESULTS: A total of 1410 patients with Crohn's disease underwent surgery for their disease. The surgical rate decreased by 8.4% each year (95% CI, -9.6% to -7.3%). There was a 36.2% increase in the use of anti-TNF therapy per year (95% CI, 31.3% to 41.5%). Changes in modifiable risk factors for surgery were also seen, including the proportion of active smokers decreasing by 2.2% per year (95% CI, -3.7% to -0.6%).CONCLUSIONS: Although anti-TNF therapy seems to play a role, the decrease in surgical trends is likely multifactorial, owing to a decline in smoking trends, earlier diagnosis, earlier treatment, improved patient education, and changes in clinical practice.