Crohn's disease after surgery: Changes in post‐operative management strategies over time and their impact on long‐term re‐operation rate—A retrospective multicentre real‐world study

Abstract

SummaryBackgroundFew data are available addressing the impact of post‐operative management of Crohn's disease (CD) on long‐term clinical course.AimTo assess the evolution of post‐operative management strategies over the last 40 years and their impact on the re‐operation rate of CD.MethodsWe included 657 patients with CD who had undergone their first radical ileo‐caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980–1998; n = 198), cohort 2 (1999–2009; n = 218) and cohort 3 (2010–2020; n = 241). We estimated exposure to immunomodulators and anti‐TNFα agents after surgery and rates of re‐operation using Kaplan–Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re‐operation.ResultsImmunosuppressants, (IMMs) and anti‐TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti‐TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re‐operation within 5 and 10 years. Multivariate analysis identified IMMs/anti‐TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77–30.21) and post‐operatively (HR: 0.24; 95% CI 0.07–0.74) as variables associated with the risk of re‐operation. However, these associations had a time‐varying effect and become non‐significant after 5 and 2 years after surgery, respectively.ConclusionDespite increased post‐operative use of IMMs and anti‐TNFα agents in the last two decades, the impact of these strategies on the risk of long‐term re‐operation rate has been modest.