P570 Prevalence and risk factors for intestinal resection in patients with Crohn’s disease in a Greek referral center
Orfanoudaki, E.(1);Foteinogiannopoulou, K.(1);Theodoraki, E.(1);Drygiannakis, I.(1);Romanos, I.(2);Koutroubakis, I.E.(1);
(1)University Hospital of Heraklion- Medical School- University of Crete, Gastroenterology, Heraklion, Greece;(2)University Hospital of Heraklion- Medical School- University of Crete, Surgical Oncology, Heraklion, Greece;
Background
Nearly half of patients with Crohn’s disease (CD) require any kind of surgical resection within 10 years after diagnosis and about one third of them need an additional second intervention within the next decade. We aimed to investigate the prevalence and risk factors for intestinal resection in Greek patients with CD.
Methods
Consecutive CD patients with complete follow up data, recorded prospectively in a registry of a tertiary university hospital from 2011-2021, were studied retrospectively. All patients with a history of at least one bowel resection for luminal disease were enrolled. Surgeries for perianal disease, fistulae or other complications were excluded. At the same time, the role of potential risk factors for surgical intervention was analyzed.
Results
Out of a total of 372 CD patients recorded in the database, 85 patients (23%) with a history of 96 surgical resections were identified. Sixty one percent were male, with a mean (±SD) age of 48.5 (±15.3) years, median (IQR) age at disease diagnosis 25.5 (21-37) years, 39% smokers, L1 49%, L2 11%, L3 40%, B2 57% and B3 37%.
Median (IQR) time from diagnosis to first surgical resection was 58 (8.3-120.8) months, while in 17% the diagnosis was made with the surgery. Half of the patients (52%) were operated due to no response to treatment, presenting with ileus or stricture formation, whereas other causes for operation were perforation ± abscess (24%) and dysplasia (4%) [20% cause not specified in files]. Fifty three percent were naïve to biologic treatment prior to surgery and needed resection sooner that those experienced to biologics [median (IQR) time from diagnosis to surgery 12 (0-72) vs 88 (46-172) months, p<0.0001]. A second surgery became necessary in 11 patients (13%) due to disease recurrence after a mean (±SD) time of 152 (±117) months after the first, whereas only one needed a third one.
In the univariate analysis bowel resection was associated with younger age at diagnosis (p<0.0001), shorted disease duration (p<0.0001), structural and fistulizing phenotype (p<0.001) and smoking (p=0.0017). All associations remained significant also in the multivariate analysis (Table 1).
Conclusion
One out of four patients in our cohort needed bowel resection for their luminal CD with younger age at diagnosis, shorter disease duration, structuring/fistulizing phenotype and smoking being identified as possible risk factors.