title: Factors that determine risk for surgery in pediatric patients with Crohn's disease.
abstract: OBJECTIVE
  We examined the incidence of Crohn's disease (CD)-related surgery in a multi-center, inception cohort of pediatric patients with CD. We also examined the effect of starting immunomodulator therapy within 30 days of diagnosis.
  
  
  METHODS
  Data from 854 children with CD from the Pediatric Inflammatory Bowel Disease Collaborative Research Group who were diagnosed with CD between 2002 and 2008 were analyzed.
  
  
  RESULTS
  Overall, 76 (9%) underwent a first CD-related surgery, 57 (7%) underwent a first bowel surgery (bowel resection, ostomy, strictureplasty, or appendectomy), and 19 (2%) underwent a first non-bowel surgery (abscess drainage or fistulotomy). The cumulative risks for bowel surgery, non-bowel surgery, and all CD-related surgeries were 3.4%, 1.4%, and 4.8%, respectively, at 1 year after diagnosis and 13.8%, 4.5%, and 17.7%, respectively, at 5 years after diagnosis. Older age at diagnosis, greater disease severity, and stricturing or penetrating disease increased the risk of bowel surgery. Disease between the transverse colon and rectum decreased the risk. Initiation of immunomodulator therapy within 30 days of diagnosis, sex, race, and family history of inflammatory bowel disease did not influence the risk of bowel surgery.
  
  
  CONCLUSIONS
  In an analysis of pediatric patients with CD, the 5-year cumulative risk of bowel surgery was lower than that reported in recent studies of adult and pediatric patients but similar to that of a recent retrospective pediatric study. Initiation of immunomodulator therapy at diagnosis did not alter the risk of surgery within 5 years of diagnosis.
authors.affiliation: Pediatric Inflammatory Bowel Disease Collaborative Research Group, Hartford, Connecticut, USA.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Schaefer
authors.forename: Jason T
authors.initials: JT
authors.lastname: Machan
authors.forename: David
authors.initials: D
authors.lastname: Kawatu
authors.forename: Christine R
authors.initials: CR
authors.lastname: Langton
authors.forename: James
authors.initials: J
authors.lastname: Markowitz
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
authors.forename: David R
authors.initials: DR
authors.lastname: Mack
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Evans
authors.forename: Marian D
authors.initials: MD
authors.lastname: Pfefferkorn
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Otley
authors.forename: Athos
authors.initials: A
authors.lastname: Bousvaros
authors.forename: Subra
authors.initials: S
authors.lastname: Kugathasan
authors.forename: Joel R
authors.initials: JR
authors.lastname: Rosh
authors.forename: David J
authors.initials: DJ
authors.lastname: Keljo
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Carvalho
authors.forename: Gitit
authors.initials: G
authors.lastname: Tomer
authors.forename: Petar
authors.initials: P
authors.lastname: Mamula
authors.forename: Marsha H
authors.initials: MH
authors.lastname: Kay
authors.forename: Benny
authors.initials: B
authors.lastname: Kerzner
authors.forename: Maria
authors.initials: M
authors.lastname: Oliva-Hemker
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Shehzad A
authors.initials: SA
authors.lastname: Saeed
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hyams
authors.forename: Neal S
authors.initials: NS
authors.lastname: Leleiko
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018570:Risk Assessment
chemical_list: D007155:Immunologic Factors