title: Cumulative incidence of second intestinal resection in Crohn's disease: a systematic review and meta-analysis of population-based studies.
abstract: OBJECTIVE
  Approximately 50% of Crohn's disease patients undergo an intestinal resection within 10 years of diagnosis. The risk of second surgery in Crohn's disease and the influence of time are not well characterized. We performed a systematic review and meta-analysis to establish the risk of second abdominal surgery in patients with Crohn's disease among patients who had a previous surgery.
  
  
  METHODS
  We searched Medline, EMBASE, PubMed (March 2014), and conference proceedings for terms related to Crohn's disease and intestinal surgery. We included population-based articles (n=11) and an abstract (n=1) reporting surgical risk for the overall study period and for 5 and 10 years after the first surgery for Crohn's disease. We stratified studies by year (start year before vs. after 1980) to explore the role of time.
  
  
  RESULTS
  For all population-based studies, the overall risk of second surgery was 28.7% (95% confidence interval (CI): 22.6-36.6%). The 5-year risk of second surgery was 24.2% (95% CI: 22.3-26.4%). The 10-year risk of second surgery was 35.0% (95% CI: 31.8-38.6%). A significant difference in the 10-year risk of second surgery was observed over time such that studies conducted after 1980 had a lower risk of second surgery (33.2%; 95% CI: 31.2-35.4%) compared with those that started before 1980 (44.6%; 95% CI: 37.7-52.7%).
  
  
  CONCLUSIONS
  Approximately one-quarter of Crohn's disease patients who have a first surgery also have a second, and the majority of these surgeries occur within 5 years of the first surgery. The 10-year risk of second surgery is significantly decreasing over time.
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Alexandra D
authors.initials: AD
authors.lastname: Frolkis
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Debra S
authors.initials: DS
authors.lastname: Lipton
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada [3] Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: María E
authors.initials: ME
authors.lastname: Negrón
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada [3] Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dykeman
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: deBruyn
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada [3] Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jette
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Talia
authors.initials: T
authors.lastname: Frolkis
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Rezaie
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Seow
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: 1] Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences and Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D006801:Humans; D015994:Incidence; D012086:Reoperation; D012307:Risk Factors