OP016 Need for primary abdominal surgery, but not repeated surgery, has decreased: a nationwide study of temporal trends in Crohn surgery in Sweden 1990–2014
D. Kalman1*, C. Nordenvall2, A. Hallqvist Everhov3, J.F. Ludvigsson4, M.C. Sachs5, A. Ekbom6, O. Olén7, P. Myrelid1
1Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland, Linköping, Sweden, 2Department of Molecular Medicine and Surgery, Karolinska Institutet; Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden, 3Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden, 4Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA, Stockholm, Sweden, 5Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, 6Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden, 7Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs’ Children and Youth Hospital, Stockholm, Sweden
During the last two decades medical therapy for Crohn’s disease has been rapidly evolving with the aim of preventing complications necessitating surgery. In earlier studies, about 50% of the patients needed abdominal surgery within 10 years and of these 50% had a surgical relapse within another 10 years. Some population-based studies have shown decreasing surgical rates preceding modern medical therapy, but data are conflicting.
All incident patients with at least two diagnostic listings of Crohn’s disease and no previous bowel surgery in the Swedish Patient Register 1990–2014 were included in this nationwide cohort study (
Cumulative incidence of abdominal surgery during all available follow-ups of 19 648 patents with Crohsn’s disease.
Cumulative incidence of second abdominal surgery during all available follow-ups of 5998 patients with Crohn’s disease previously operated.
The 5-year cumulative incidence of any abdominal surgery were 53% and 40% in 1990–1995 and 1996–2000, and 20%, 18% and 13% for the patients diagnosed in 2001–2003, 2004–2009 and 2010–2014, respectively. The cumulative incidence for first abdominal surgery within 10 years were 59% and 44% for the two first cohorts and 25% and 21% for the cohorts diagnosed in 2001–2003 and 2004–2009. The cumulative incidence of a second abdominal procedure was 18% and 15% 5 years following the primary surgery among those diagnosed in 1990–1995 and 1996–2000. The rate of surgical relapse did not decrease during the two most recent calendar periods.
The cumulative incidence of first ever abdominal surgery in Swedish patients with Crohn’s disease has decreased and is lower than previously reported, especially for the most recent calendar periods with a 5- and 10-year cumulative incidence of 13% and 21%, respectively. The need of a second abdominal procedure is, in general, very low compared with previous studies, but with no significant temporal changes in recent years despite a decade with more potent and costly medical treatments available.