Crohn\u2019s disease: a population-based study of surgery in the age of biological therapy

Christian Stöss,Dirk Wilhelm,Helmut Friess,Philipp-Alexander Neumann,Ulrich Nitsche,Maximilian Berlet,Marie-Christin Weber,Stefan Reischl

doi:10.1007/s00384-021-03930-w

Abstract

PurposeDespite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease.MethodsNationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed.ResultsA total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low.ConclusionDespite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.

Highlights

The central role of medical treatment for Crohn’s disease (CD) is the early prevention of disease progression through immunosuppressive therapy
While the gender and age distribution for the disease did not change during the study period, the number of inpatient CD cases significantly increased by 10.6% (n = 23,301 in 2010 vs. n = 26,069 in 2017; p = 0.0005) (Fig. 1a)
Coding for small intestine CD increased over the study period (2010: 34%; 2017: 38%), whereas CD of the large intestine remained widely the same (2010: 25%; 2017: 24%) (Table 1)

Summary

Introduction

The central role of medical treatment for Crohn’s disease (CD) is the early prevention of disease progression through immunosuppressive therapy. The development of biologic agents, such as antibodies against tumor necrosis factor (TNF) alpha, has led to significant change in the medical treatment of CD [1]. After the initial approval of the anti-TNF antagonist infliximab, medical therapy for CD has advanced rapidly. There has been a paradigm shift in the way medical treatment is approached: early use of biologics is. The aim of this study was to analyze the development of CD with special reference to surgical treatment within the last decade. Int J Colorectal Dis (2021) 36:2419–2426 performed to assess all inpatient CD cases from 2010 to 2017 in Germany. The number of hospitalizations and surgical procedures for CD were summarized, and surgical complications as well as in-hospital mortality are presented

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