Incidence and characteristics of pediatric patients with Crohn's disease undergoing surgery: A cross‐sectional study

TL;DR

This study finds that surgery rates for pediatric Crohn's disease dropped significantly after 2019, likely due to faster use of biologic treatments.

Contribution

The study provides new insights into the impact of early biologic therapy on reducing surgery rates in pediatric Crohn's disease.

Findings

Surgery rates were 5.6/1000 person-years before 2019 and 14.7/1000 person-years after 2019.

Earlier biologic initiation (14 days after 2019 vs. 142 days before) likely contributed to the surgery rate decline.

The overall surgery incidence was 5.2/1000 person-years at the study center.

Abstract

Despite biological treatments reducing the burden of pediatric inflammatory bowel disease, many patients still require surgery. Data on pediatric patient characteristics and surgical incidence are limited, often based on adult studies. This study aimed to assess the characteristics of pediatric Crohn's disease (CD) at diagnosis and compare surgery rates between two periods (before and after 2019) to understand which patients require surgery.

We analyzed pediatric CD patients who underwent surgery at CHU Sainte‐Justine, Montreal, between 2014 and 2023. Descriptive statistics and the Mann–Whitney U‐test were used to compare means, while Kaplan–Meier curves assessed surgery‐free survival, with significance set at p < 0.05.

The overall surgery incidence was 5.2/1000 person‐years. Surgery rates were lower for patients diagnosed after 2019 than before 2019 (5.6/1000 vs. 14.7/1000 person‐years). There were no significant differences in age at diagnosis, CD Paris score, reason for surgery, or disease severity. Among CD patients, surgeries were more frequent before 2019 (11.5% vs. 2.8%, p < 0.001). The reduction in surgery rates since 2019 is likely due to earlier initiation of biologics, with a median initiation of 14 days after 2019 compared to 142 days before 2019 (p = 0.01).

The reduced incidence of surgery in pediatric CD is a significant achievement. Increased use of infliximab, proactive drug monitoring, and better nonresponder management likely contribute to this improvement.

The prevalence of Crohn's disease (CD) is constantly increasing, particularly in Canada.Despite the addition of multiple biologics and small molecules, surgery remains a necessary treatment for selected patients.

The prevalence of Crohn's disease (CD) is constantly increasing, particularly in Canada.

Despite the addition of multiple biologics and small molecules, surgery remains a necessary treatment for selected patients.

This is one of the recent North American studies to establish the incidence of CD surgery in a tertiary pediatric center (5.2/1000 person‐years).This study supports the idea that the rapid initiation of biologics, along with proper treatment optimization, can have an impact on reducing the surgery rate in pediatric CD.

This is one of the recent North American studies to establish the incidence of CD surgery in a tertiary pediatric center (5.2/1000 person‐years).

This study supports the idea that the rapid initiation of biologics, along with proper treatment optimization, can have an impact on reducing the surgery rate in pediatric CD.

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