Declining hospitalisation and surgical intervention rates in patients with Crohn's disease: a population‐based cohort

Abstract

Summary Background Lifetime risk of surgery in patients with Crohn's disease remains high. Aim To assess population‐level markers of Crohn's disease (CD) in the era of biological therapy. Methods Population‐based cohort study using administrative data from Ontario, Canada including 45 235 prevalent patients in the Ontario Crohn's and Colitis Cohort (OCCC) from 1 April 2003 to 31 March 2014. Results CD‐related hospitalisations declined 32.4% from 2003 to 2014 from 154/1000 (95% confidence interval (CI) [150, 159]) patients to 104/1000 (95% CI [101, 107]) (P < .001). There was a 39.6% decline in in‐patient surgeries from 53/1000 (95% CI [50, 55]) to 32/1000 (95% CI [30, 34]) from 2003 to 2014 (P < .001). In‐patient surgeries were mostly bowel resections. Out‐patient surgeries increased from 8/1000 (95% CI [7, 9]) patients to 12/1000 (95% CI [10, 13]) (P < .001). Out‐patient surgeries were largely related to fistulas and perianal disease and for stricture dilations/stricturoplasty. CD‐related emergency department (ED) visits declined 28.4% from 141/1000 (95% CI [137, 146]) cases to 101/1000 (95% CI [99, 104]) from 2003 to 2014 (P < .001). Over the same time, patients receiving government drug benefits received infliximab or adalimumab at a combined rate of 2.2% in 2003 which increased to 18.8% of eligible patients by 2014. Conclusions Rates of hospitalisations, ED visits and in‐patient surgeries markedly declined in Ontario over the study period, while rates of biologic medication use increased markedly for those receiving public drug benefits.

Time Trends of Crohn’s Disease in Catalonia from 2011 to 2017. Increasing Use of Biologics Correlates with a Reduced Need for Surgery

“…Therefore, our study suggests that the increase in the use of biological drugs was associated to a reduction in the need for surgery and hospitalization due to complications, although causality cannot be concluded. These data from a large population-based health register of clinical practice, along with the data recently published by Rahman A, et al [ 19 ] in a population-based study from Ontario between 2003 and 2014 (Canada), corroborate previous data obtained in the clinical trials reported above [ 7 , 8 , 9 , 10 ].…”

Risk Factors for and Frequency of CT Scans, Steroid Use, and Repeat Visits in Inflammatory Bowel Disease Patients Seen at a Single-Center Emergency Department: A Retrospective Cohort Study

“…Importantly, we found a decrease in the likelihood of repeated ED visits in patients who were being treated with biologics for IBD, indicating that appropriate IBD treatment may reduce the risk of repetitive visits and potentially translate to appreciable cost-savings. Consistent with this, Rahman et al found that rates of hospitalizations, ED visits, and inpatient surgeries markedly declined for Crohn’s patients in Ontario from 2003 to 2014, while rates of biologic medication use increased [ 28 ]. This information is reassuring; repeat ED visits are less likely to be for IBD and appropriate IBD treatment seems to play a role in preventing repeat visits.…”

Natural history of inflammatory bowel disease: a comparison between the East and the West

“…65 In a population-based study from Ontario, Canada, CD-related hospitalizations decreased by 32% from 154/1,000 patients in 2003 to 104/1,000 patients in 2014. 72 In the SK-IBD cohort, the cumulative risks of hospitalization at 1, 5, 10, and 20 years after CD diagnosis were 31.2%, 40.7%, 51.9%, and 67.9%, respectively. 30 The cumulative risk of hospitalization was significantly lower in the recent cohort than in the older cohort, with the 5-year cumulative risk of hospitalization being 52.2% in the 1986-2003 cohort and 36.6% in the 2004-2015 cohort.…”

“…The cumulative risks of hospitalization in the SK-IBD cohort were similar to or slightly lower than those in Western population-based cohort studies. 33,65,71,72…”