Cumulative incidence of second intestinal resection in Crohn's disease: A systematic review and meta-Analysis of population-based studies

Alexandra D. Frolkis, Debra S. Lipton, Kirsten M. Fiest, María E. Negrón, Jonathan Dykeman, Jennifer Debruyn, Nathalie Jette, Talia Frolkis, Ali Rezaie, Cynthia H. Seow, Remo Panaccione, Subrata Ghosh, Gilaad G. Kaplan

Research output: Contribution to journalArticlepeer-review

143 Scopus citations

Abstract

OBJECTIVES:Approximately 50% of Crohn's disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and the influence of time are not well characterized. We performed a systematic review and meta-Analysis to establish the risk of second abdominal surgery in patients with Crohn's disease among patients who had a previous surgery.METHODS:We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn's disease and intestinal surgery. We included population-based articles (n=11) and an abstract (n=1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn's disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time.RESULTS:For all population-based studies, the overall risk of second surgery was 28.7% (95% confidence interval (CI): 22.6-36.6%). The 5-year risk of second surgery was 24.2% (95% CI: 22.3-26.4%). The 10-year risk of second surgery was 35.0% (95% CI: 31.8-38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2-35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7-52.7%).CONCLUSIONS:Approximately one-quarter of Crohn's disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.

Original languageEnglish
Pages (from-to)1739-1748
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume109
Issue number11
StatePublished - 13 Nov 2014
Externally publishedYes

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