Background: Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course.

Aim: To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD.

Methods: We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation.

Results: Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively.

Conclusion: Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.

Download full-text PDF

Source
http://dx.doi.org/10.1111/apt.18001DOI Listing

Publication Analysis

Top Keywords

post-operative management
12
crohn's disease
8
management strategies
8
cohort cohort
8
cohort
6
surgery
4
disease surgery
4
surgery changes
4
changes post-operative
4
strategies time
4

Similar Publications

Background: Total knee arthroplasty (TKA) is an effective treatment for end-stage knee osteoarthritis, and postoperative rehabilitation is crucial. However, a comprehensive bibliometric analysis of this area has yet to emerge. This study aims to visualize the research trends in postoperative rehabilitation after TKA through bibliometric analysis and explore current research frontiers and hotspots.

View Article and Find Full Text PDF

Background: Duloxetine, a serotonin and norepinephrine reuptake inhibitor (SNRI), is used to treat various health conditions, including major depressive disorder, generalized anxiety disorder, fibromyalgia, and off-label for chemotherapy-induced pain. We conducted this systematic review and meta-analysis aiming to test the current evidence regarding effectiveness and safety of duloxetine for postspine surgeries pain.

Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed, Scopus and Web of science databases for relevant articles up to March 2024.

View Article and Find Full Text PDF

Introduction: Hereditary bleeding disorders stem from the absence or insufficient levels of particular clotting proteins, essential for facilitating coagulation in the clotting cascade. Among the most prevalent are hemophilia A (deficiency of Factor VIII), hemophilia B (deficiency of Factor IX), and von Willebrand disease. Management of pharmacoresistant epilepsy is more difficult in a patient with bleeding disorder due to increased risk of bleeding during surgery.

View Article and Find Full Text PDF

Introduction And Importance: Insulinomas are rare pancreatic neuroendocrine neoplasms with an incidence of one to four cases per million annually and a 5 % to 10 % association with hereditary multiple endocrine neoplasia type-1. While most insulinomas are benign and well-encapsulated, approximately 6 % may have malignant potential. Intraoperative localization remains a vital component of treatment, often facilitated by modern imaging techniques like intraoperative ultrasound and fluorescence modalities.

View Article and Find Full Text PDF

Background & Aims: Enhanced Recovery After Surgery (ERAS) has shown significant improvements in postoperative outcomes and a reduction in complications, while immunonutrition (IMN) has been shown to modulate the immune system and inflammatory response. However, many studies have overlooked the crucial aspects of nutrition status and patient perception within the intervention approach. This study aims to investigate the efficacy and explore patients' acceptance of the IMN intervention in postoperative outcomes among gynecological cancer (GC) patients under the ERAS framework.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!