Risk factors for surgery and postoperative recurrence: analysis of a south China cohort with Crohn's disease

Abstract

Background and aims. To investigate the risk factors for primary surgery and postoperative recurrence in a cohort of Chinese Crohn's disease (CD) patients. Methods. Medical notes of consecutive diagnosed patients from 2003 until 2010 were reviewed. Fifty-seven postoperative patients – finished regular follow-up – were recruited for postoperative recurrence analysis. Results. One hundred eleven of 323 (34.4%) patients of this cohort underwent primary surgery. The cumulative frequency of resection was 16.6%, 35.4%, 53%, and 94.5% for 1, 5, 10, and 30 years, respectively, after onset of disease. Male (OR: 1.994; 95% CI: 1.291–3.078, p = 0.002), stricture (OR: 4.832; 95% CI: 3.064–7.621, p = 0.000), or penetrating (OR: 4.923; 95% CI: 3.060–7.919, p = 0.000) were associated with an increased risk for primary surgery, while early use of immunomodulators was (OR: 0.438; 95% CI: 0.218–0.880, p = 0.020) associated with a decreased risk. Fifty-seven (21.1%) patients were diagnosed as postoperative clinical recurrence and the cumulative recurrence rates were 6.1%, 17.1%, and 36.8% for 1, 2, and 3 years, respectively. Perianal disease was associated with an increased risk for clinical recurrence (OR: 5.606; 95% CI: 1.59–19.766, p = 0.007). Conclusions. The operation frequency is high in CD. Male, penetrating, and stricture diseases are associated with an increased risk for primary surgery while early use of immunomodulators is associated with a decreased risk. The postoperative recurrence rate is also high. Patients with perianal disease are at higher risk for clinical recurrence.

Key Words::

• Crohn's disease
• postoperative recurrence
• risk factor
• surgery

Acknowledgement

Xiang Gao: conception and design, drafting the article and revising it, final approval of the version to be published. Rong-ping Yang: acquisition of data, drafting the article, final approval of the version to be published. Min-hu Chen: analysis and interpretation of data, drafting the article, final approval of the version to be published. Ying-lian Xiao: acquisition of data, drafting the article, final approval of the version to be published. Yao He: acquisition of data, drafting the article, final approval of the version to be published. Bai-li Chen: acquisition of data, drafting the article, final approval of the version to be published. Pin-jin Hu: conception, revising the article, final approval of the version to be published.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.