Altmetric

Emerging trends and risk factors for perianal surgery in Crohn's disease: a 20-year national population-based cohort study

File Description SizeFormat 
Trends_in_perianal_Crohn final accepted IBD.pdfAccepted version733.55 kBAdobe PDFView/Open
Title: Emerging trends and risk factors for perianal surgery in Crohn's disease: a 20-year national population-based cohort study
Authors: Chhaya, V
Saxena, S
Cecil, E
Subramanian, V
Curcin, V
Majeed, A
Pollok, RC
Item Type: Journal Article
Abstract: Background: Little is known about the rates of perianal surgery (PAS) in Crohn’s disease (CD). Our aim was to determine trends in PAS, the timing of surgery relative to the diagnosis of CD and to identify subgroups at risk of PAS. Materials and methods: We identified 9391 incident cases of CD between 1989 and 2009. We defined three eras: era 1 (1989–1995), era 2 (1996–2002) and era 3 (2003–2009), and determined trends in procedure type and the time to first PAS relative to the date of diagnosis. We used Kaplan–Meier analysis to calculate the rate of first PAS and performed Cox regression to determine subgroups at risk of PAS. Results: Among the 9391 incident cases of CD, 405 (4.3%) underwent PAS. The overall rate of PAS was 5.5% [95% confidence interval (CI): 4.9–6.2%] 10 years after diagnosis. 34% (n=137) of all patients undergoing PAS had surgery in the 5 years before CD diagnosis. Abscess drainage increased from 34 to 58%, whereas proctectomy decreased from 16 to 6% between eras 1 and 3, respectively. Men [hazard rate (HR) 1.51, 95% CI: 1.24–1.84], those aged 17–40 years (HR 1.69, 95% CI: 1.09–2.02 vs. those aged >40 years) and those with a history of previous intestinal resection (HR 28.5, 95% CI: 22.2–36.5) were more likely to have PAS. Conclusion: Around one-third of patients have a PAS in the 5 years preceding their diagnosis of CD. Surgical practice has changed over 20 years, with a decrease in proctectomy and a concurrent increase in abscess drainage that is likely to reflect improvements in therapeutic practice.
Issue Date: 1-Aug-2016
Date of Acceptance: 14-Mar-2016
URI: http://hdl.handle.net/10044/1/49965
DOI: https://dx.doi.org/10.1097/MEG.0000000000000651
ISSN: 0954-691X
Publisher: Wolters Kluwer
Start Page: 890
End Page: 895
Journal / Book Title: European Journal of Gastroenterology & Hepatology
Volume: 28
Issue: 8
Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Funder's Grant Number: CDF-2011-04-048
NIHR-CDF-2011-04-048
09GP01
09GP01
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Crohn's disease
fistula
perianal surgery
proctectomy
INFLAMMATORY-BOWEL-DISEASE
PRACTICE RESEARCH DATABASE
SURGICAL-TREATMENT
THIOPURINE TREATMENT
MEDICAL-TREATMENT
NATURAL-HISTORY
CLASSIFICATION
DURATION
FISTULAS
SMOKING
Adolescent
Adult
Anal Canal
Anus Diseases
Chi-Square Distribution
Crohn Disease
Databases, Factual
Digestive System Surgical Procedures
Drainage
Female
Humans
Incidence
Kaplan-Meier Estimate
Male
Population Surveillance
Practice Patterns, Physicians'
Proportional Hazards Models
Risk Assessment
Risk Factors
Time Factors
Time-to-Treatment
United Kingdom
Young Adult
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Creative Commons