title: Optimizing perioperative Crohn's disease management: role of coordinated medical and surgical care.
abstract: OBJECTIVE
  To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating medical therapy after Crohn's disease (CD) surgery at a tertiary care referral center.
  
  
  METHODS
  CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery.
  
  
  RESULTS
  Eighty-eight patients met study inclusion criteria with 92% (n=81) of patients returning for surgical follow-up compared to only 41% (n=36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P<0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery.
  
  
  CONCLUSIONS
  Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Jennifer L
authors: JL
authors: Bennett
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Christina Y
authors: CY
authors: Ha
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Jonathan E
authors: JE
authors: Efron
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Susan L
authors: SL
authors: Gearhart
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Mark G
authors: MG
authors: Lazarev
authors: Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States.
authors: Elizabeth C
authors: EC
authors: Wick
mesh_terms: D000328:Adult; D015142:Baltimore; D003113:Colonoscopy / Q000592:standards; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000175:diagnosis / Q000601:surgery*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D062209:Patient Handoff / Q000458:organization & administration / Q000592:standards; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents
keywords: Coordinated care; Crohn’s disease; Multidisciplinary clinics; Post-operative prophylaxis; Surgery
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