Abstract

Contemporary Risk of Surgery in Patients With Ulcerative Colitis and Crohn's Disease: A Meta-Analysis of Population-Based Cohorts

Clin Gastroenterol Hepatol. 2021 Oct;19(10):2031-2045.e11.doi: 10.1016/j.cgh.2020.10.039. Epub 2020 Oct 27.

Lester Tsai 1, Christopher Ma 2, Parambir S Dulai 1, Larry J Prokop 3, Samuel Eisenstein 4, Sonia L Ramamoorthy 4, Brian G Feagan 5, Vipul Jairath 5, William J Sandborn 1, Siddharth Singh 6

 
     

Author information

  • 1Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California.
  • 2Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
  • 3Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota.
  • 4Division of Colorectal Surgery, Department of Surgery, University of California San Diego, La Jolla, California.
  • 5Division of Gastroenterology, University of Western Ontario, London, Ontario, Canada.
  • 6Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California

Abstract

Background & aims: We conducted a systematic review with meta-analysis to estimate rates and trends of colectomy in patients with ulcerative colitis (UC), and of primary and re-resection in patients with Crohn's disease (CD), focusing on contemporary risks.

Methods: Through a systematic review until September 3, 2019, we identified population-based cohort studies that reported patient-level cumulative risk of surgery in patients with UC and CD. We evaluated overall and contemporary risk (after 2000) of surgery and analyzed time trends through mixed-effects meta-regression.

Results: In patients with UC (26 studies), the overall 1-, 5-, and 10-year risks of colectomy was 4.0% (95% CI, 3.3-5.0), 8.8% (95% CI, 7.7-10.0), and 13.3% (95% CI, 11.3-15.5), respectively, with a decrease in risk over time (P < .001). Corresponding contemporary risks were 2.8% (95% CI, 2.0-3.9), 7.0% (95% CI, 5.7-8.6), and 9.6% (95% CI, 6.3-14.2), respectively. In patients with CD (22 studies), the overall 1-, 5-, and 10-year risk of surgery was 18.7% (95% CI, 15.0-23.0), 28.0% (95% CI, 24.0-32.4), and 39.5% (95% CI, 33.3-46.2), respectively, with a decrease in risk over time (P < .001). Corresponding contemporary risks were 12.3% (95% CI, 10.8-14.0), 18.0% (95% CI, 15.4-21.0), and 26.2% (95% CI, 23.4-29.4), respectively. In a meta-analysis of 8 studies in patients with CD with prior resection, the cumulative risk of a second resection at 5 and 10 years after the first resection was 17.7% (95% CI, 13.5-22.9) and 31.3% (95% CI, 24.1-39.6), respectively.

Conclusions: Patient-level risks of surgery have decreased significantly over time, with a 5-year cumulative risk of surgery of 7.0% in UC and 18.0% in CD in contemporary cohorts. This decrease may be related to early detection and/or better treatment.

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