Crohn’s disease: Risk of surgery among newly diagnosed patients

BACKGROUND AND OBJECTIVE: Medical treatment and treatment goals for Crohn's disease (CD) have evolved over the past 20 years. The aim of the study was to assess the cumulative risk of surgery in newly diagnosed CD patients in all age groups over this period. METHODS: Recently diagnosed CD patients were retrieved from the registry of the Social Insurance Institution of Finland and data on surgeries from the Finnish Institute for Health and Welfare. The focus was on major intestinal surgery. Patients were stratified according to the year of diagnosis into three study periods: 2000-2006, 2007-2013, and 2014-2020. RESULTS: We identified 11,329 recently diagnosed CD patients, of whom 1959 underwent surgery. The cumulative risks of surgery were 8.2%, 13.8%, and 18.7% at 1, 5, and 10 years post diagnosis, respectively. Surgical treatment was more frequent in male patients (IRR = 1.20, CI = 1.10-1.32). The pediatric group (age < 20 years) and the elderly (age ⩾ 60 years) had a higher risk of surgery (IRR = 1.24, CI = 1.10-1.39 and IRR = 1.20, CI = 1.07-1.34, respectively) compared to adults (aged 20-59 years at diagnosis). Adults had a lower risk of undergoing surgery in later periods than in the first period (IRR = 0.55, CI = 0.49-0.62). The pediatric group demonstrated reduction only in the last study period (IRR = 0.25, CI = 0.18-0.34). Elderly patients had a stable risk (IRR = 1.04, CI = 0.82-1.31) with 5-year risk increasing in the last period (IRR = 1.45, CI = 1.08-1.96). CONCLUSIONS: The risk of surgery among patients with newly diagnosed Crohn's disease is declining. The risk was also decreasing in the pediatric population, whereas in the elderly it remained stable or increased.