Trends in the Surgical Management of Crohn's Disease.
BACKGROUND
Although medical management of Crohn's disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions.


METHODS
We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn's-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed.


RESULTS
A total of 355,239 Crohn's-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction.


CONCLUSIONS
Crohn's-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
Cristina B
CB
Geltzeiler
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
Kyle D
KD
Hart
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
Kim C
KC
Lu
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
Karen E
KE
Deveney
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA.
Daniel O
DO
Herzig
Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA. tsikitis@ohsu.edu.
Vassiliki L
VL
Tsikitis
D000328:Adult; D003125:Colostomy / Q000706:statistics & numerical data / Q000639:trends*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data / Q000639:trends*; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014481:United States; D015431:Weight Loss
Crohn’s Disease; Crohn’s-related surgical interventions; Perianal fistulizing disease; Stoma constructions