title: Risk factors and indications for first surgery in Crohn's disease patients.
abstract: OBJECTIVE
  Despite appropriate medical treatment, a large part of CD patients undergo surgery. In this study, we aimed to identify the risk factors and indications for first surgery in CD patients.
  
  
  METHODS
  The clinical records of 289 consecutive Japanese CD patients treated at 23 hospitals between January 1981 and August 2003 were reviewed. Clinical factors, including gender, age at onset, year at onset, and disease extent were examined, in order to identify the risk factors for first surgery. In addition, indications for first surgery were investigated, and stratified by these risk factors.
  
  
  RESULTS
  A total of 113 (39%) patients underwent surgery at least once. Female gender (RR, 1.62; 95% CI, 1.09-2.41), and disease affecting the ileum (RR, 2.06; 95% CI, 1.20-3.53) were identified as the independent risk factors for surgery. In addition, female CD patients were more likely to undergo first surgery due to the indication of perforation than male patients (25% vs. 6%, p=0.006). Recent clinical and demographic changes of Japanese CD patients, such as increases in female and aged patients, did not affect the surgical risk factors and indications.
  
  
  CONCLUSIONS
  Female CD patients should be consulted with special attention to the high risk of surgery due to perforation.
authors.affiliation: Department of Gastroenterology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Morimoto
authors.forename: Jun
authors.initials: J
authors.lastname: Kato
authors.forename: Motoaki
authors.initials: M
authors.lastname: Kuriyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Junichirou
authors.initials: J
authors.lastname: Nasu
authors.forename: Jiro
authors.initials: J
authors.lastname: Miyaike
authors.forename: Takechiyo
authors.initials: T
authors.lastname: Morita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.forename: Seiyuu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Junji
authors.initials: J
authors.lastname: Shiode
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Kohsaku
authors.initials: K
authors.lastname: Sakaguchi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shiratori
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D003424:Crohn Disease / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors