title: Risk of early surgery for Crohn's disease: implications for early treatment strategies.
abstract: 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.
authors.affiliation: Gastrointestinal Unit and Center for the Study of IBD, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 7, Boston, MA 02114, USA.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Arsenault
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
authors.forename: Mazen
authors.initials: M
authors.lastname: Alsahli
authors.forename: Laurence
authors.initials: L
authors.lastname: Bailen
authors.forename: Peter
authors.initials: P
authors.lastname: Banks
authors.forename: Steven
authors.initials: S
authors.lastname: Bensen
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: David
authors.initials: D
authors.lastname: Cave
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Cooley
authors.forename: Herbert L
authors.initials: HL
authors.lastname: Cooper
authors.forename: Susan T
authors.initials: ST
authors.lastname: Edwards
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Farrell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Griffin
authors.forename: David W
authors.initials: DW
authors.lastname: Hay
authors.forename: Alex
authors.initials: A
authors.lastname: John
authors.forename: Sheldon
authors.initials: S
authors.lastname: Lidofsky
authors.forename: Lori B
authors.initials: LB
authors.lastname: Olans
authors.forename: Mark A
authors.initials: MA
authors.lastname: Peppercorn
authors.forename: Richard I
authors.initials: RI
authors.lastname: Rothstein
authors.forename: Michael A
authors.initials: MA
authors.lastname: Roy
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Saletta
authors.forename: Samir A
authors.initials: SA
authors.lastname: Shah
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Warner
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Wolf
authors.forename: James
authors.initials: J
authors.lastname: Vecchio
authors.forename: Harland S
authors.initials: HS
authors.lastname: Winter
authors.forename: John K
authors.initials: JK
authors.lastname: Zawacki
mesh_terms: 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