Clinical professor, chief physician
Mark A. Ainsworth
Department of Medical Gastroenterology
| Project management | ||
| Project status | Open | |
| Data collection dates | ||
| Start | 01.04.2022 | |
| End | 31.12.2025 | |
Prophylaxis of post-operative recurrence in patients with Crohn's disease; indications and practice
Short summary
Crohn's disease (CD) often recurs after surgery, prompting risk-based postoperative prophylaxis (POP). This retrospective study at Odense University Hospital assessed guideline adherence and POP efficacy in CD patients undergoing resection (2017-2022). Patients were classified as high- or low-risk based on prognostic factors. Clinical and endoscopic recurrence rates were analyzed. Findings question the effectiveness of current risk stratification and POP strategies.
Rationale
Crohn's disease (CD) is a chronic inflammatory gastrointestinal disorder with no curative treatment. Management aims to maintain remission, primarily through medical therapy (biologics, immunomodulators, and corticosteroids) and surgical interventions. Many CD patients eventually require intestinal resection, but postoperative recurrence is common. Risk factors for recurrence include smoking, previous resections, penetrating disease, and extensive small bowel involvement. Clinical guidelines recommend postoperative prophylaxis (POP) based on risk stratification, with high-risk patients receiving immunosuppressive therapy (e.g., TNF inhibitors, thiopurines, or antibiotics). However, recent studies have questioned the effectiveness of POP in preventing recurrence, particularly in patients with prior exposure to TNF inhibitors. This study aimed to assess adherence to guideline recommendations for POP in CD patients and evaluate the impact of adherence on postoperative recurrence. The underlying hypothesis was that risk-stratified POP improves patient outcomes by reducing recurrence rates.
Description of the cohort
A retrospective, single-center study was conducted at Odense University Hospital, analyzing all CD patients who underwent intestinal resection between February 1, 2017, and January 31, 2022. Patients were categorized as high-risk (HR) or low-risk (LR) based on known prognostic factors (e.g., smoking, young age at onset, previous resections, and extensive resection).
Data and biological material
Data were extracted from electronic medical records, including demographic details, disease characteristics, surgical procedures, and medical treatments pre- and post-surgery. Patients were further stratified based on whether they received immediate POP (within 30 days) or delayed POP (within six months).
Collaborating researchers and departments
Department of Medical Gastroenterology, Odense University Hospital