Risk of early surgery for Crohn's disease: implications for early treatment strategies.
OBJECTIVE
In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease.


METHODS
We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors.


RESULTS
Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery.


CONCLUSIONS
The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that improved risk stratification and potent therapies with rapid onset of action are needed to modify the natural history of Crohn's disease.
Sands
Bruce E
BE
Gastrointestinal Unit and Center for the Study of IBD, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 7, Boston, MA 02114, USA.
Arsenault
Joanne E
JE
Rosen
Michael J
MJ
Alsahli
Mazen
M
Bailen
Laurence
L
Banks
Peter
P
Bensen
Steven
S
Bousvaros
Athos
A
Cave
David
D
Cooley
Jeffrey S
JS
Cooper
Herbert L
HL
Edwards
Susan T
ST
Farrell
Richard J
RJ
Griffin
Michael J
MJ
Hay
David W
DW
John
Alex
A
Lidofsky
Sheldon
S
Olans
Lori B
LB
Peppercorn
Mark A
MA
Rothstein
Richard I
RI
Roy
Michael A
MA
Saletta
Michael J
MJ
Shah
Samir A
SA
Warner
Andrew S
AS
Wolf
Jacqueline L
JL
Vecchio
James
J
Winter
Harland S
HS
Zawacki
John K
JK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009511:New England; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome