Surgical Rates for Crohn’s Disease are Decreasing: A Population-Based Time Trend Analysis and Validation Study

Abstract

Objectives:Temporal changes for intestinal resections for Crohn’s disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.Methods:First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections. Second, we used these validated codes to conduct population-based surveillance between fiscal years 2002 and 2010 to identify adult CD patients undergoing intestinal resection (n=981). Annual surgical rate was calculated by dividing incident surgeries by estimated CD prevalence. Time trend analysis was performed and annual percent change (APC) with 95% confidence intervals (CI) in surgical resection rates were calculated using a generalized linear model assuming a Poisson distribution.Results:In the validation cohort, 101/104 (97.1%) patients undergoing surgery and 191/200 (95.5%) patients admitted without surgery were confirmed to have CD on chart review. Among the 116 administrative database codes for surgical resection, 97.4% were confirmed intestinal resections on chart review. From 2002 to 2010, the overall CD surgical resection rate was 3.8 resections per 100 person-years. During the study period, rate of surgery decreased by 3.5% per year (95% CI: −1.1%, −5.8%), driven by decreasing emergent operations (−10.1% per year (95% CI: −13.4%, −6.7%)) whereas elective surgeries increased by 3.7% per year (95% CI: 0.1%, 7.3%).Conclusions:Overall surgical resection rates in CD are decreasing, but a paradigm shift has occurred whereby elective operations are now more commonly performed than emergent surgeries.

Reduction in surgical stoma rates in Crohn's disease: a population‐based time trend analysis

“…The overall decrease in surgical stoma‐formation rates mirrors observations that rates of surgical resections in CD may be on the decline , as may rates of colectomy for ulcerative colitis . A previous study from our unit demonstrated that reductions in overall intestinal resection rates in CD were also attributable to a decrease in emergency procedures: from 2002 to 2010, emergency bowel resections decreased by 10.1% (95% CI: −13.4 to −6.7) per year . However, our finding that rates of permanent stoma formation in CD have remained stable contrasts the results of a previous study by Coscia et al .…”

“…In this population-based study, we demonstrated that both emergency and temporary stomaformation rates in CD have decreased, although this has not been paralleled by a change in the rate of permanent stoma formation. The overall decrease in surgical stoma-formation rates mirrors observations that rates of surgical resections in CD may be on the decline [3,4,18,19], as may rates of colectomy for ulcerative colitis [20]. A previous study from our unit demonstrated that reductions in overall intestinal resection rates in CD were also attributable to a decrease in emergency procedures: from 2002 to 2010, emergency bowel resections decreased by 10.1% (95% CI: À13.4 to À6.7) per year [4].…”

“…The overall decrease in surgical stoma-formation rates mirrors observations that rates of surgical resections in CD may be on the decline [3,4,18,19], as may rates of colectomy for ulcerative colitis [20]. A previous study from our unit demonstrated that reductions in overall intestinal resection rates in CD were also attributable to a decrease in emergency procedures: from 2002 to 2010, emergency bowel resections decreased by 10.1% (95% CI: À13.4 to À6.7) per year [4]. However, our finding that rates of permanent stoma formation in CD have remained stable contrasts the results of a previous study by Coscia et al [11], who demonstrated a significant difference in the proportion of patients requiring a permanent stoma in prebiological (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) vs biological (post-2002) eras (60.8 vs 19.2%, P < 0.001) and that biological use was associated with a significant increase in rectal preservation.…”

Inflammatory bowel disease: estimates from the global burden of disease 2017 study

“…We additionally reported these estimates and their trends by age group (5)(6)(7)(8)(9)(10)(11)(12)(13)(14), 50-69 and ≥70 years old) and sex. We investigated the burden of IBD by geographic macro-regions and quintiles of socio-demographic index (SDI).…”

“…Globally, between 1990 and 2017, the prevalence of IBD in children Low-middle SDI L ow SDI mortality. 10,11 Several studies have also reported decreasing trends for colectomy in ulcerative colitis (UC), 12,13 Crohn's disease (CD) 14,15 and overall IBD. 16 These findings suggest significant improvements in preventing the most severe outcomes associated with disease progression.…”