Real-World Surgical and Endoscopic Recurrence Based on Risk Profiles and Prophylaxis Utilization in Postoperative Crohn's Disease

Ravi S. Shah, Salam Bachour, Abel Joseph, Huijun Xiao, Ruishen Lyu, Hareem Syed, Terry Li, Shravya Pothula, Vall Vinaithirthan, Adel Hajj Ali, Sussel Contreras, Jessica H. Hu, Edward L. Barnes, Jordan E. Axelrad, Stefan D. Holubar, Miguel Regueiro, Benjamin L. Cohen, Benjamin H. Click

Research output: Contribution to journalArticlepeer-review

Abstract

Background & Aims: Preoperative risk stratification may help guide prophylactic biologic utilization for the prevention of postoperative Crohn's disease (CD) recurrence; however, there are limited data exploring and validating proposed clinical risk factors. We aimed to explore the preoperative clinical risk profiles, quantify individual risk factors, and assess the impact of biologic prophylaxis on postoperative recurrence risk in a real-world cohort. Methods: In this multicenter retrospective analysis, patients with CD who underwent ileocolonic resection (ICR) from 2009 to 2020 were identified. High-risk (active smoking, ≥2 prior surgeries, penetrating disease, and/or perianal disease) and low-risk (nonsmokers and age >50 y) features were used to stratify patients. We assessed the risk of endoscopic (Rutgeert score, ≥i2b) and surgical recurrence by risk strata and biologic prophylaxis (≤90 days postoperatively) with logistic and time-to-event analyses. Results: A total of 1404 adult CD patients who underwent ICR were included. Of the high-risk factors, 2 or more ICRs (odds ratio [OR], 1.71; 95% CI, 1.13–2.57), active smoking (OR, 1.73; 95% CI, 1.17–2.53), penetrating disease (OR, 1.41; 95% CI, 1.02–1.94), and history of perianal disease alone (OR, 1.99; 95% CI, 1.42–2.79) were associated with surgical but not endoscopic recurrence. Surgical recurrence was lower in high-risk patients receiving prophylaxis vs not (10.2% vs 16.7%; P = .02), and endoscopic recurrence was lower in those receiving prophylaxis irrespective of risk strata (high-risk, 28.1% vs 37.4%; P = .03; and low-risk, 21.1% vs 38.3%; P = .002). Conclusions: Clinical risk factors accurately illustrate patients at risk for surgical recurrence, but have limited utility in predicting endoscopic recurrence. Biologic prophylaxis may be of benefit irrespective of risk stratification and future studies should assess this.

Original languageEnglish
Pages (from-to)847-857.e12
JournalClinical Gastroenterology and Hepatology
Volume22
Issue number4
DOIs
StatePublished - Apr 2024
Externally publishedYes

Keywords

  • Biologics
  • Postoperative
  • Prophylaxis
  • Recurrence

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