title: Factors associated with operative recurrence early after resection for Crohn's disease.
abstract: BACKGROUND
  Some Crohn's disease (CD) patients develop rapid disease recurrence requiring reoperation. Identification of factors associated with early operative recurrence of CD may help risk-stratify patients and prevent recurrence.
  
  
  METHODS
  Prospectively collected data of CD patients undergoing bowel resection for CD with unequivocal evidence of recurrence at reoperation were retrieved. Patients with earlier recurrence (less than median time of recurrence of study cohort) were compared with those who developed later recurrence (greater than median time of recurrence) for patient and disease characteristics and risk factors for recurrence. A multivariate logistic regression model was performed to identify factors associated with earlier operative recurrence.
  
  
  RESULTS
  Sixty-nine patients (45 female, 24 male) met the inclusion criteria. Median time to reoperation was 38 months (range, 3.3-236 months). One hundred six reoperations in the 69 patients were for abscess/fistula/perforation (n = 45), stricture/stenosis (n = 41), inflammation (n = 17), bleeding (n = 2), and dysplasia (n = 1). Factors associated with early rather than late reoperation included behavior of disease (stricturing, odds ratio (OR) 12.1; confidence interval (CI), 1.8-80.9; penetrating OR, 9.9; CI, 1.4-67.9 rather than nonstricturing nonpenetrating) and the development of postoperative complications at previous surgery (OR, 12.1; CI, 1.2-126.6).
  
  
  CONCLUSIONS
  Earlier recurrence of CD requiring reoperation is associated with specific disease and potentially modifiable operation-related factors such as postoperative complications, i.e., anastomotic leak or intraabdominal abscess. Strategies to reduce recurrence in such patients include the identification of factors that may reduce postoperative complications.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
authors.forename: Wisam
authors.initials: W
authors.lastname: Khoury
authors.forename: Scott A
authors.initials: SA
authors.lastname: Strong
authors.forename: Victor W
authors.initials: VW
authors.lastname: Fazio
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D057868:Anastomotic Leak / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D003424:Crohn Disease / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D018450:Disease Progression; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology; D007412:Intestinal Fistula / Q000209:etiology*; D007416:Intestinal Perforation / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors