title: Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies.
abstract: OBJECTIVE
  The inflammatory bowel diseases (IBDs) are chronic diseases that often require surgery. However, the risk of requirement of surgery over time has not been well characterized. We performed a systematic review and meta-analysis to establish the cumulative risk of surgery among patients with IBD and evaluated how this risk has changed over time.
  
  
  METHODS
  We searched Medline, EMBASE, PubMed, and conference proceedings (2009-2012) on May 8, 2013, for terms related to IBD and intestinal surgery. Two reviewers screened 8338 unique citations to identify 486 for full-text review. The analysis included population-based studies published as articles (n = 26) and abstracts (n = 4) that reported risks of surgery at 1, 5, or 10 years after a diagnosis of Crohn's disease and/or ulcerative colitis. The trend in risk of surgery over time was analyzed by meta-regression using mixed-effect models.
  
  
  RESULTS
  Based on all population-based studies, the risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease was 16.3% (95% confidence interval [CI], 11.4%-23.2%), 33.3% (95% CI, 26.3%-42.1%), and 46.6% (95% CI, 37.7%-57.7%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of ulcerative colitis was 4.9% (95% CI, 3.8%-6.3%), 11.6% (95% CI, 9.3%-14.4%), and 15.6% (95% CI, 12.5%-19.6%), respectively. The risk of surgery 1, 5, and 10 years after diagnosis of Crohn's disease and 1 and 10 years after diagnosis of ulcerative colitis has decreased significantly over the past 6 decades (P < .05).
  
  
  CONCLUSIONS
  Based on systematic review and meta-analysis of population-based studies, the risk of intestinal surgery among patients with IBD has decreased over the past 6 decades.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences and Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alexandra D
authors.initials: AD
authors.lastname: Frolkis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dykeman
authors.forename: María E
authors.initials: ME
authors.lastname: Negrón
authors.forename: Jennifer
authors.initials: J
authors.lastname: Debruyn
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.forename: Talia
authors.initials: T
authors.lastname: Frolkis
authors.forename: Herman W
authors.initials: HW
authors.lastname: Barkema
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Rioux
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.forename: Samuel
authors.initials: S
authors.lastname: Wiebe
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States
keywords: CI; IBD; Inflammatory Bowel Diseases; Meta-analysis; Surgery; Systematic Review; TNF; confidence interval; inflammatory bowel disease; tumor necrosis factor