title: Risk factors for initial surgery in patients with Crohn's disease in Central China.
abstract: OBJECTIVE
  To establish the risk factors for initial surgery in patients with Crohn's disease (CD) in Central China.
  
  
  METHODS
  The subjects of this study were patients with CD treated at Zhongnan Hospital of Wuhan University, an IBD center in Wuhan City, Central China, between January, 1992 and June, 2012. We conducted uni- and multivariate analyses of the risk factors for initial surgery for CD in these patients.
  
  
  RESULTS
  A total of 197 patients with CD were included in this study. The cumulative incidence of initial surgery was 21.8, 28.9, and 32.5%, at 1, 5, and 10 years, respectively, after the onset of symptoms. Analysis using multivariate Cox models showed that the relative risk for initial surgery was lower in patients who were younger than 16 years at diagnosis (HR = 0.57, 95% CI 0.34-0.96, P = 0.034). The risk increased in patients with stricturing (HR = 4.75, 95% CI 2.48-9.11), those with CD showing penetrating behavior at diagnosis (HR = 5.14, 95% CI 2.54-10.39), and those with a history of appendectomy (HR = 1.87, 95% CI 1.03-3.40). Azathioprine (AZA) treatment appeared to decrease the risk for initial surgery in patients with non-penetrating and non-stricturing CD (HR = 0.14, 95% CI 0.13-3.10).
  
  
  CONCLUSIONS
  Age at diagnosis, disease behavior, and a history of appendectomy appeared to have an impact on the risk for initial surgery. AZA treatment might be helpful for decreasing the risk of needing initial surgery for patients in whom stricturing or fistulizing disease has not yet developed.
authors.affiliation: Department of Gastroenterology, Zhongnan Hospital of Wuhan University School of Medicine, Donghu Road 169, Wuhan, 430071, People's Republic of China, chenmin8106@aliyun.com.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Fengming
authors.initials: F
authors.lastname: Yi
authors.forename: Feng
authors.initials: F
authors.lastname: Zhou
authors.forename: Meifang
authors.initials: M
authors.lastname: Huang
authors.forename: Jin
authors.initials: J
authors.lastname: Li
authors.forename: Wenfeng
authors.initials: W
authors.lastname: Yan
authors.forename: Lixia
authors.initials: L
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Xia
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001062:Appendectomy; D002648:Child; D002681:China; D003424:Crohn Disease / Q000601:surgery / Q000628:therapy*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: C488629:azathiopurine; D015122:Mercaptopurine