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. 2017 Dec;112(12):1840-1848.
doi: 10.1038/ajg.2017.394. Epub 2017 Oct 31.

Surgical Rates for Crohn's Disease are Decreasing: A Population-Based Time Trend Analysis and Validation Study

Christopher Ma  1 , Gordon W Moran  2 , Eric I Benchimol  3   4 , Laura E Targownik  5 , Steven J Heitman  1 , James N Hubbard  1 , Cynthia H Seow  1 , Kerri L Novak  1 , Subrata Ghosh  6 , Remo Panaccione  1 , Gilaad G Kaplan  1
Affiliations

Surgical Rates for Crohn's Disease are Decreasing: A Population-Based Time Trend Analysis and Validation Study

Christopher Ma et al. Am J Gastroenterol. 2017 Dec.

Erratum in

Abstract

Objectives: Temporal changes for intestinal resections for Crohn's disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.

Methods: First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections. Second, we used these validated codes to conduct population-based surveillance between fiscal years 2002 and 2010 to identify adult CD patients undergoing intestinal resection (n=981). Annual surgical rate was calculated by dividing incident surgeries by estimated CD prevalence. Time trend analysis was performed and annual percent change (APC) with 95% confidence intervals (CI) in surgical resection rates were calculated using a generalized linear model assuming a Poisson distribution.

Results: In the validation cohort, 101/104 (97.1%) patients undergoing surgery and 191/200 (95.5%) patients admitted without surgery were confirmed to have CD on chart review. Among the 116 administrative database codes for surgical resection, 97.4% were confirmed intestinal resections on chart review. From 2002 to 2010, the overall CD surgical resection rate was 3.8 resections per 100 person-years. During the study period, rate of surgery decreased by 3.5% per year (95% CI: -1.1%, -5.8%), driven by decreasing emergent operations (-10.1% per year (95% CI: -13.4%, -6.7%)) whereas elective surgeries increased by 3.7% per year (95% CI: 0.1%, 7.3%).

Conclusions: Overall surgical resection rates in CD are decreasing, but a paradigm shift has occurred whereby elective operations are now more commonly performed than emergent surgeries.

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Conflict of interest statement

Guarantor of the article: Gilaad Kaplan, MD, MPH, FRCPC.

Specific author contributions: C.M. contributed to study design, data collection, data analysis, and manuscript drafting. G.W.M. contributed to study design and manuscript drafting. E.I.B. contributed to study design and manuscript editing. J.N.H. contributed to data analysis. L.T., S.J.H., C.H.S., K.L.N., S.G., and R.P. contributed to manuscript editing. G.G.K. contributed to study design, data analysis, and manuscript editing.

Financial support: Dr G. Kaplan is a Canadian Institutes of Health Research Embedded Clinician Research Chair. Dr E. Benchimol was supported by a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology and Crohn’s and Colitis Canada. He was also supported by the Canadian Child Health Clinician Scientist Program Career Enhancement Program.

Potential competing interests: G.M. has received consultancy fees from AbbVie, Takeda, Janssen, and Dr Falk; speaker fees from Merck Sharp, Dohme Ltd, AbbVie, Ferring, Janssen, and Takeda; and financial support for educational activities from AbbVie, Merck Sharp, Dohme Ltd, Ferring, and Dr Falk. L.T. has served on the advisory boards for Pfizer, Takeda, AbbVie, and Janssen and received speaking fees from Janssen, Takeda, and Pfizer. She has received grant support from Pfizer and AbbVie. C.S. has participated in advisory board meetings for Janssen, AbbVie, Shire, Takeda, and Actavis. She has received speaker fees from Janssen and AbbVie. K.N. has served as a speaker for AbbVie and Janssen. She has participated in advisory board meetings for AbbVie, Janssen, Pfizer, and Ferring. She has received research support from AbbVie and Janssen. S.G. has participated in advisory board meetings for Centocor, Abbott, Merck, Schering Plough, Proctor & Gamble, Shire, UCB Pharma, Pfizer, and Millennium. He has received research support from Proctor & Gamble, Merck, Schering-Plough and speaking fees from Merck, Schering-Plough, Centocor, Abbott, UCB Pharma, Pfizer, Ferring, and Proctor & Gamble. R.P. has participated in advisory board meetings for Abbott/AbbVie, Amgen, Janssen, Merck, Pfizer, Prometheus Laboratories, Salix Pharma, Shire, Takeda, and Warner Chilcott. He has received consulting fees from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca, Baxter, BMS, Centocor, Elan/Biogen, Eisai, Ferring, GSK, Janssen, Merck, Millennium, Pfizer, Proctor & Gamble, Prometheus Therapeutics and Diagnostics, Schering-Plough, Shire, Takeda, UCB Pharma, and Warner Chilcott. Dr R.P. has received research support from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca, Baxter, BMS, Centocor, Eisai, Elan/Biogen, Ferring, GSK, Janssen, Merck, Millennium, Pfizer, Proctor & Gamble, Prometheus, Shire, Schering-Plough, Takeda, UCB Pharma, and Warner Chilcott. He has received speaking fees from Abbott/AbbVie, Amgen, Aptalis, Astra Zeneca, Baxter, BMS, Centocor, Eisai, Elan/Biogen, Ferring, GSK, Janssen, Merck, Millennium, Pfizer, Proctor & Gamble, Prometheus, Schering-Plough, Shire, Takeda, UCB Pharma, and Warner Chilcott. G.K. has served as a speaker for Janssen, Merck, Schering-Plough, Abbvie, and UCB Pharma. He has participated in advisory board meetings for Janssen, Abbvie, Merck, Schering-Plough, Shire, and UCB Pharma. Dr G.K. has received research support from Merck, Abbvie, GlaxoSmith Kline, and Shire. The remaining authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Identification of surgical intestinal resection validation cohort and negative control cohort from the Data Integration, Measurement and Reporting Discharge Database (2011).
Figure 2
Figure 2
Decreasing annual surgical resection rates for Crohn’s disease from fiscal years 2002 to 2010 in the Calgary Health Zone. Resection rates stratified by elective (blue) vs. non-elective surgeries (red).
See this image and copyright information in PMC

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