Younger Age and Post-op Complications Increase Likelihood of Repeat Crohnʼs Surgery Despite Biologic Use

Abstract

Purpose: It is well-known that recurrence of Crohn's disease (CD) untreated after surgery is common. It is estimated that up to 80% of patients with CD may require surgery during their lifetime, and up to 75% who have had surgery will require another operation. There is evidence to suggest that post-op biologic use may protect against the need for additional surgeries. In this study, we sought to identify factors which may impact effectiveness of post-op biologic use in preventing repeat surgery. Methods: We performed a case-control study of patients with a diagnosis of CD who had undergone surgery for complications of CD at the University of Alabama at Birmingham from 2006 to 2010, and were continued or started on biologics post-op. Patients were >18 years old at the time of initial surgery, had established histological diagnosis of CD prior to initial surgery, their surgery was performed for complications related to CD, and patients were followed for at least three years from initial surgery. Repeat surgery within one year of initial surgery was an exclusion criterion. Patients who underwent repeat surgery between 1-3 years after initial surgery were designated as cases, and those who did not represented controls. Results: Of 84 patients who underwent surgery for CD at our institution, eight were lost to follow-up, and 32 patients were continued or started on biologics post-op. None of these 32 patients required repeat surgery within one year of the initial surgery. Between 1-3 years post-op, 15 (47%) required repeat surgery (cases), whereas 17 (53%) did not need repeat surgery (controls). We did not observe any significant difference between cases and controls in regard to age at diagnosis, BMI, gender, ethnicity, behavior, or location of CD. However, patients who required repeat surgery were younger at initial surgery (P=0.002). Moreover, complication after initial surgery was also associated with repeat surgery (P=0.0009). Successive adjusted logistic regression models were examined to assess independent associations. The final adjusted logistic regression model demonstrated that among patients on biologics, complication of initial surgery was highly associated with the need for repeat surgery at 1-3 years post-op (odds ratio [OR] 28.32; 95% confidence interval [CI] 2.43-330.61; P=0.008). Younger age at initial surgery was also independently associated with a higher likelihood of repeat surgery (OR 1.15; 95% CI 1.03-1.28; P=0.014). Conclusion: The purpose and main objective of this study was to identify factors that predict the need for another surgery among patients on biological agents. It was seen that in this group, younger age and post-op complications were both risks factors for repeat surgery.