Real-World Surgical and Endoscopic Recurrence Based on Risk Profiles and Prophylaxis Utilization in Postoperative Crohn’s Disease

Abstract

Background & AimsPreoperative risk stratification may help guide prophylactic biologic utilization for the prevention of postoperative Crohn's disease (CD) recurrence; however, there is limited data exploring and validating proposed clinical risk factors. We aimed to explore preoperative clinical risk profiles, quantify individual risk factors, and assess the impact of biologic prophylaxis on postoperative recurrence (POR) risk in a real-world cohort. MethodsIn this multicenter retrospective analysis, patients with CD who underwent ileocecal resection (ICR) from 2009-2020 were identified. High-risk (active smoking, ≥2 prior surgeries, penetrating and/or perianal disease) and low-risk (nonsmokers and age>50 years) features were used to stratify patients. We assessed the risk of endoscopic (Rutgeerts’ score ≥i2b) and surgical recurrence by risk strata and biologic prophylaxis (≤90 days postoperatively) with logistic and time-to-event analyses. ResultsA total of 1404 adult CD patients who underwent ICR were included. Of the high-risk factors, ≥2 ICR (OR 1.71; 95% CI [1.13-2.57]), active smoking (OR 1.73, 95% CI [1.17-2.53]), penetrating disease (OR 1.41, 95% CI [1.02-1.94]), and history of perianal disease alone (OR 1.99, 95% CI [1.42-2.79]) were associated with surgical but not endoscopic recurrence. Surgical recurrence was lower in high-risk patients receiving prophylaxis versus not (10.2% vs 16.7%; p=0.02), and endoscopic recurrence was lower in those receiving prophylaxis irrespective of risk strata (High-risk: 28.1% vs 37.4%; p=0.03 and Low-risk: 21.1% vs 38.3%; p=0.002). ConclusionsClinical risk factors accurately illustrate patients at risk for surgical recurrence, but have limited utility in predicting endoscopic recurrence. Biologic prophylaxis may be of benefit irrespective of risk stratification and future studies should assess this.