Characterization of risk factors and postoperative pharmacological prophylaxis patterns affecting re-resection in Crohn's disease with surgical recurrence.

Abstract

Background: Limited research has focused on the characterization of Crohn's disease (CD) patients with surgical recurrence. This study aimed to evaluate risk factors and postoperative pharmacological prophylaxis patterns for surgical recurrence in CD.

Methods: Data were obtained from 349 CD patients over a 5-year follow-up after initial bowel surgery. Risk factors and postoperative pharmacological prophylaxis patterns affecting re-resection were analyzed. Multivariate Cox regression analysis was also used to identify risk factors for surgical recurrence. A nomogram was created to guide postoperative disease surveillance.

Results: A total of 349 CD patients were enrolled, with a median follow-up time of 68.0 months after surgery. The overall cumulative risk of surgical recurrence was 9.7% at 5 years. In a multivariate Cox regression analysis, stricturing and penetrating behavior, extensive small bowel resection, residual lesions, postoperative complications, and postoperative step-up to biologic therapy were the factors independently associated with an increased risk of surgical recurrence (P < 0.05). A nomogram with these variables had good predictive accuracy for surgical recurrence (C-index = 0.767). Kaplan-Meier curves showed that patients with residual lesions had a higher probability of surgical recurrence (P = 0.004). Furthermore, there were significantly more patients who received early step-up to biologics after primary bowel surgery within 8 weeks in the no-recurrence group (P = 0.014).

Conclusion: Several risk factors were found in CD patients with surgical recurrence, and a nomogram predicting surgical recurrence could guide individual postoperative management to avoid reoperations. Postoperative pharmacological prophylaxis patterns with early step-up to biologics might reduce the re-rection incidence.