Gastroenterology

Gastroenterology

Volume 115, Issue 2, August 1998, Pages 259-267
Gastroenterology

Alimentary Tract
Risk factors for early postoperative recurrence of Crohn's disease

https://doi.org/10.1016/S0016-5085(98)70191-XGet rights and content
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Abstract

Background & Aims: Despite many advances in our understanding of Crohn's disease, the course of the disease in any given patient remains unpredictable. There is little agreement as to which factors increase a patient's risk of early postoperative recurrence. We have attempted to identify predictors of early recurrence after surgical resection, specifically whether the indication for initial surgery (perforating or nonperforating) or the duration of preoperative disease may be associated with early recurrence. Methods: We studied 88 patients who had undergone at least two resections for Crohn's disease. Multivariable survival analysis was performed to elucidate predictors of early postoperative recurrence. Results: A perforating indication for initial surgery (P < 0.001) and a longer preoperative disease duration (P = 0.004) were found to be the only independent predictors of earlier postoperative recurrence after initial surgery. A longer preoperative disease duration also showed a borderline significant association with a shorter interval from second to third surgery (P = 0.075). Finally, the indication for initial surgery was predictive of the indication at a subsequent surgery for recurrence (P = 0.001). Conclusions: A perforating indication for initial resection and a longer duration of disease before initial surgery predicted an earlier postoperative recurrence. The latter association was borderline. This suggests that prognostic groups based on these factors may help to stratify patients with regard to risk of early recurrence.

GASTROENTEROLOGY 1998;115:259-267

Abbreviations

CI
confidence interval
HR
hazard ratio
NP
nonperforating
OR
odds ratio
P
perforating

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Address requests for reprints to: Gary R. Lichtenstein, M.D., Gastrointestinal Division, Department of Internal Medicine, Hospital of the University of Pennsylvania School of Medicine, 3 Ravdin Building, 3400 Spruce Street, Philadelphia, Pennsylvania 19104-4283. Fax: (215) 349-5915.