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National trends in intestinal resection for Crohn’s disease in the post-biologic era

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Prior international datasets have demonstrated equivocal results in the rate of surgical procedures for the treatment of Crohn’s disease (CD) following the introduction of biologic medications. The first biologic medication licensed for use in the Republic of Ireland (ROI) was infliximab in 1999. The current study examined national trends in intestinal resection for CD in the ROI following the introduction of biologic medications.

Methods

The Irish Hospital In-Patient Enquiry database was examined for the period 2000–2010. Cases of CD and relevant surgical interventions were identified using International Classification of Diseases, ninth and tenth editions. Using Irish census data to establish population denominators, trends in population-based procedure rates were examined. Trends were tested for significance with Spearman rank tests.

Results

From 2000 to 2010, there were 11,796 patient admissions with a principal diagnosis of CD. The rates of admission for CD overall (r 2 = −0.191, P = 0.574) and for emergencies (r 2 = 0.055, P = 0.873) did not change; however, elective admissions reduced (r 2 = −0.636, P = 0.035). The mean length of stay reduced (r 2 = −0.783, P = 0.004). The rates of small bowel/right colon procedures (r 2 = 0.282, P = 0.401) and proctectomy (r 2 = −0.209, P = 0.537) did not change. Left colon procedures reduced (r 2 = −0.800, P = 0.003) while the rate of total colectomy increased (r 2 = 0.718, P = 0.013).

Conclusions

During the decade following the introduction of biologic medications in the ROI, the rate of elective hospitalization and length of stay reduced. However, there has not been a dramatic reduction in the rate of intestinal resection for Crohn’s disease at a population level.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Limerick, Limerick, Ireland

    John P. Burke & J. Calvin Coffey

  2. Graduate Entry Medical School, University of Limerick, Limerick, Ireland

    Yoga Velupillai & J. Calvin Coffey

  3. Centre for Colorectal Disease, St Vincent’s University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland

    P. Ronan O’Connell

  4. Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland

    J. Calvin Coffey

Authors
  1. John P. Burke
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  2. Yoga Velupillai
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  3. P. Ronan O’Connell
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  4. J. Calvin Coffey
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Correspondence to J. Calvin Coffey.

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Burke, J.P., Velupillai, Y., O’Connell, P.R. et al. National trends in intestinal resection for Crohn’s disease in the post-biologic era. Int J Colorectal Dis 28, 1401–1406 (2013). https://doi.org/10.1007/s00384-013-1698-5

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  • DOI: https://doi.org/10.1007/s00384-013-1698-5

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