Itabashi Michio    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor (Fixed Term)
Article types	Original article
Language	English
Peer review	Non peer reviewed
Title	Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease.
Journal	Formal name：Clinical gastroenterology and hepatology Abbreviation：Clin Gastroenterol Hepatol ISSN code：15427714/15423565
Domestic / Foregin	Foregin
Volume, Issue, Page	18(4),pp.898-907
Author and coauthor	Shinagawa Takahide, Hata Keisuke, Ikeuchi Hiroki, Fukushima Kouhei, Futami Kitaro, Sugita Akira, Uchino Motoi, Watanabe Kazuhiro, Higashi Daijiro, Kimura Hideaki, Araki Toshimitsu, Mizushima Tsunekazu, Itabashi Michio, Ueda Takeshi, Koganei Kazutaka, Oba Koji, Ishihara Soichiro, Suzuki Yasuo
Publication date	2020/04
Summary	BACKGROUND & AIMS:Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments.METHODS:We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model.RESULTS:The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup.CONCLUSIONS:The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
DOI	10.1016/j.cgh.2019.07.025
PMID	31336198