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Trends in the Surgical Management of Crohn’s Disease

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Although medical management of Crohn’s disease has changed in recent years, it is unclear whether surgical management has altered. We examined rate changes of surgical interventions, stoma constructions, and subset of ileostomy and colostomy constructions.

Materials and Methods

We reviewed the Nationwide Inpatient Sample database from 1988 to 2011. We examined the number of Crohn’s-related operations and stoma constructions, including ileostomies and colostomies; a multivariable logistic regression model was developed.

Results

A total of 355,239 Crohn’s-related operations were analyzed. Operations increased from 13,955 in 1988 to 17,577 in 2011, p < 0.001. Stoma construction increased from 2493 to 4283, p < 0.001. The subset of ileostomies increased from 1201 to 3169, p < 0.001 while colostomies decreased from 1351 to 1201, p = 0.05. Operation percentages resulting in stoma construction increased from 18 to 24 %, p < 0.001. Weight loss (OR 2.25, 95 % CI 1.88, 2.69) and presence of perianal fistulizing disease (OR 2.91, 95 % CI 2.31, 3.67) were most predictive for requiring stoma construction.

Conclusions

Crohn’s-related surgical interventions and stoma constructions have increased. The largest predictors for stoma construction are weight loss and perianal fistulizing disease. As a result, nutrition should be optimized and the early involvement of a multidisciplinary team should be considered.

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Acknowledgments

Contributor Thank You:

The authors would like to thank Brian Diggs, PhD for his assistance with the initial statistical review of this project.

The authors would like to thank Mary Kwatkosky-Lawlor for her assistance with the review process and the preparation of the bibliography.

Conflict of Interest

The authors declare that they have no competing interests.

Author Contributions

All authors have made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, and drafting the article or revising it critically for intellectual content. All authors have approved the current version to be published.

Paper Category

Inflammatory bowel disease, Crohn’s disease

Funding Support

There were no sources of funding or support for this publication.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Colorectal Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Mail Code L223A, 97239, Portland, OR, USA

    Cristina B. Geltzeiler, Kyle D. Hart, Kim C. Lu, Karen E. Deveney, Daniel O. Herzig & Vassiliki L. Tsikitis

Authors
  1. Cristina B. Geltzeiler
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  2. Kyle D. Hart
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  3. Kim C. Lu
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  4. Karen E. Deveney
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  5. Daniel O. Herzig
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  6. Vassiliki L. Tsikitis
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Corresponding author

Correspondence to Vassiliki L. Tsikitis.

Appendix A

Appendix A

Crohn’s-related operations

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Geltzeiler, C.B., Hart, K.D., Lu, K.C. et al. Trends in the Surgical Management of Crohn’s Disease. J Gastrointest Surg 19, 1862–1868 (2015). https://doi.org/10.1007/s11605-015-2911-3

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  • DOI: https://doi.org/10.1007/s11605-015-2911-3

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