P245. Determining patient & disease related risk factors for the development of clinical recurrence following ileocolic resection for Crohn's disease within a tertiary IBD unit

Background

Ileocolic resection is reserved for patients with moderate to severe Crohn's disease (CD) [1]. Postoperative clinical recurrence (CR) can occur in up to 26% in the first year and 41% within 5 years [2]. Predicting the risk of early CR is key in determining appropriate treatment strategies. Current studies suggest a history of smoking, recurrent surgery and penetrating disease contribute to early CR [2,3]. Our study aims to determine patient and disease related preoperative risk factors for the development of early CR within a tertiary referral unit.

Methods

We retrospectively reviewed case notes of 147 subjects who underwent ileocolic resection for CD over a six year period. All patient (gender, smoking history, family history) and disease (age of disease onset, disease location, disease phenotype and surgical CD history) related variables were extracted. CR was defined as an initiation or change in medical treatment for recurrent symptoms with endoscopic or radiological evidence of active disease. Time to CR was measured in months after surgery. Univariate analysis was performed using the log rank test and multivariate analysis was performed using cox regression analysis.

Results

One hundred and thirty-one subjects had long term follow up data. Fifty-two developed CR (39.7%). On univariate analysis, ileocolic (p = 0.053) and recurrent surgery (p = 0.057) were associated with earlier CR.

Multivariate analysis demonstrates that ileocolonic disease (p = 0.013) and recurrent surgery (p = 0.024) are both significantly associated with the presence of earlier CR when adjusting for all disease related variables.

Figure: Kaplan–Meier survival analysis - time in remission for (a) disease location and (b) Crohn's disease surgical history.