Impact of biologics on stoma creation and reversal in Crohn's disease: a retrospective analysis from 2007 to 2021.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Techniques in Coloproctology Pub Date : 2025-01-07 DOI:10.1007/s10151-024-03085-0

Y Yang, F Zhu, S Li, Z Yu, Y Xu, Y Xu, J Gong

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引用次数: 0

Abstract

Background: Trends of stoma creation at index surgery for Crohn's disease (CD) in the biologics era has not been thoroughly investigated. This study aimed to assess the impact of increasing biologics use on stoma rates at index surgery of CD, as well as identifying risk factors for the creation and nonreversal of CD-related stoma.

Methods: In this single-center retrospective analysis, consecutive CD patients who underwent index bowel surgery from 2007 to 2021 were reviewed. The rates of diverting stoma formation and reversal were compared across different time periods, delineated by January 2019, as biologics [anti-tumor necrosis factor (anti-TNF)] were included in national health insurance coverage in China. Logistic regression models and Cox proportional hazards models were utilized to assess factors influencing stoma creation and its reversal, respectively.

Results: Among 1022 CD patients, 27.9% received a diverting stoma during index surgery. Despite increasing preoperative use of biologics, the incidence of stoma creation remained statistically unchanged pre- and post-2019 (29.5% versus 25.2%; P = 0.14). Factors contributing to stoma creation included colonic and perianal involvement, penetrating CD, poorer preoperative conditions, and preoperative steroid usage, but not preoperative biologics. Among diverted patients, 68.8% underwent successful bowel restoration, with the reversal rate significantly increasing from 63.0% before 2019 to 80.2% after 2019 (P < 0.01). Patients with postoperative use of immunomodulators and biologics were more likely to have the stoma closed, with a reversal rate of 90.0% for those receiving biologics compared with 64.0% for those not.

Conclusions: Increasing prevalence of biologics did not alter the stoma rates in CD patients. Additionally, postoperative biologics were independently associated with a higher probability of stoma reversal.

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生物制剂对克罗恩病造口和逆转的影响：2007年至2021年的回顾性分析

背景：在生物制剂时代，克罗恩病（CD）指数手术造口的趋势尚未得到彻底的研究。本研究旨在评估增加生物制剂使用对CD指数手术造口率的影响，以及确定CD相关造口产生和不可逆转的危险因素。方法：在这项单中心回顾性分析中，回顾了2007年至2021年连续接受肠指数手术的CD患者。随着生物制剂[抗肿瘤坏死因子（anti-TNF）]被纳入中国的国民健康保险，在2019年1月之前，比较了不同时期的转移造口形成和逆转率。采用Logistic回归模型和Cox比例风险模型分别评价影响造口及其逆转的因素。结果：在1022例CD患者中，27.9%的患者在指数手术中接受了转移造口。尽管术前生物制剂的使用越来越多，但2019年前后造口的发生率在统计学上保持不变(29.5% vs 25.2%；p = 0.14)。导致造口的因素包括结肠和肛周受损伤、穿透性CD、术前条件较差和术前使用类固醇，但不包括术前使用生物制剂。在分流的患者中，68.8%的患者成功进行了肠道修复，逆转率从2019年之前的63.0%显著增加到2019年之后的80.2% (P结论：增加生物制剂的流行并未改变CD患者的造口率。此外，术后生物制剂与较高的造口逆转概率独立相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.