Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies

AD Frolkis, DS Lipton, KM Fiest… - Official journal of the …, 2014 - journals.lww.com
AD Frolkis, DS Lipton, KM Fiest, ME Negrón, J Dykeman, J Debruyn, N Jette, T Frolkis…
Official journal of the American College of Gastroenterology| ACG, 2014•journals.lww.com
OBJECTIVES: Approximately 50% of Crohn's disease patients undergo an intestinal
resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and
the influence of time are not well characterized. We performed a systematic review and meta-
analysis to establish the risk of second abdominal surgery in patients with Crohn's disease
among patients who had a previous surgery. METHODS: We searched Medline, EMBASE,
PubMed (March 2014), and conference proceedings for terms related to Crohn's disease …
Abstract
OBJECTIVES:
Approximately 50% of Crohn’s disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn’s disease and the influence of time are not well characterized. We performed a systematic review and meta-analysis to establish the risk of second abdominal surgery in patients with Crohn’s disease among patients who had a previous surgery.
METHODS:
We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn’s disease and intestinal surgery. We included population-based articles (n= 11) and an abstract (n= 1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn’s disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time.
RESULTS:
For all population-based studies, the overall risk of second surgery was 28.7%(95% confidence interval (CI): 22.6–36.6%). The 5-year risk of second surgery was 24.2%(95% CI: 22.3–26.4%). The 10-year risk of second surgery was 35.0%(95% CI: 31.8–38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2–35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7–52.7%).
CONCLUSIONS:
Approximately one-quarter of Crohn’s disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.
Lippincott Williams & Wilkins
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