Early surgery cuts reoperation risk, immunomodulator exposure in Crohn’s disease

Patients with Crohn’s disease (CD) who undergo resection within 29 days of diagnosis are less likely to need reoperation in the future and have lower levels of immunomodulator exposure, a recent study has found.

Researchers conducted a nationwide cohort study of 493 CD patients (group 1; median age, 49 years, 49.3 percent women) who had undergone surgery in the first 29 days after diagnosis. Outcomes were the incidence of reoperation and hospitalization and need for medication.

As comparators, 472 (group 2; median age 37 years, 57.8 percent women) and 1,518 (group 3; median age 35 years, 57.6 percent women) patients who were resected between 30 and 180 and >180 days after diagnosis, respectively, were also included.

Multivariate Cox regression analysis found that the risk of reoperation was nearly 30 percent higher in group 3 than in group 1 (hazard ratio [HR], 1.276, 95 percent confidence interval [CI], 1.027–1.586; p=0.028). Ileocecal surgery was also associated with a lower risk of reoperation than other types of resections.

Moreover, while group 1 patients were significantly more likely to need prophylactic immunomodulator treatment after surgery (group 2: HR, 0.560, 95 percent CI, 0.443–0.709; p<0.001; group 3: HR, 0.825, 95 percent CI, 0.694–0.981; p=0.03), the cumulative use of this medication in the years following surgery turned out lower in patients undergoing early resection.

In contrast, hospitalization risk was lower by 28.1 percent and 33.3 percent in groups 2 and 3, respectively, as opposed to group 1 (p<0.001 for both).