title: National trends in intestinal resection for Crohn's disease in the post-biologic era.
abstract: BACKGROUND
  Prior international datasets have demonstrated equivocal results in the rate of surgical procedures for the treatment of Crohn's disease (CD) following the introduction of biologic medications. The first biologic medication licensed for use in the Republic of Ireland (ROI) was infliximab in 1999. The current study examined national trends in intestinal resection for CD in the ROI following the introduction of biologic medications.
  
  
  METHODS
  The Irish Hospital In-Patient Enquiry database was examined for the period 2000-2010. Cases of CD and relevant surgical interventions were identified using International Classification of Diseases, ninth and tenth editions. Using Irish census data to establish population denominators, trends in population-based procedure rates were examined. Trends were tested for significance with Spearman rank tests.
  
  
  RESULTS
  From 2000 to 2010, there were 11,796 patient admissions with a principal diagnosis of CD. The rates of admission for CD overall (r(2) = -0.191, P = 0.574) and for emergencies (r(2) = 0.055, P = 0.873) did not change; however, elective admissions reduced (r(2) = -0.636, P = 0.035). The mean length of stay reduced (r(2) = -0.783, P = 0.004). The rates of small bowel/right colon procedures (r(2) = 0.282, P = 0.401) and proctectomy (r(2) = -0.209, P = 0.537) did not change. Left colon procedures reduced (r(2) = -0.800, P = 0.003) while the rate of total colectomy increased (r(2) = 0.718, P = 0.013).
  
  
  CONCLUSIONS
  During the decade following the introduction of biologic medications in the ROI, the rate of elective hospitalization and length of stay reduced. However, there has not been a dramatic reduction in the rate of intestinal resection for Crohn's disease at a population level.
authors.affiliation: Department of Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.forename: Yoga
authors.initials: Y
authors.lastname: Velupillai
authors.forename: P Ronan
authors.initials: PR
authors.lastname: O'Connell
authors.forename: J Calvin
authors.initials: JC
authors.lastname: Coffey
mesh_terms: D001685:Biological Factors / Q000627:therapeutic use*; D003082:Colectomy / Q000639:trends*; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male
chemical_list: D001685:Biological Factors