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Early specialist care after Crohn's disease surgery may decrease rehospitalization risk
Gastroenterologist care shortly after surgery for Crohn’s disease reduced patients’ risk for disease-related hospitalization years after the procedure, according to recent results.
Researchers evaluated 2,943 patients who underwent at least one surgery related to Crohn’s disease (CD) between 1996 and 2009. Participants’ health care utilization before and after the procedure were compared, and the impact of any change in use following surgery was determined.
Compared with preoperative figures, IBD-related specialist and emergency visits each decreased by 62%, the number of performed endoscopies decreased by 82%, the number of radiological procedures decreased by 78% and hospitalizations decreased by 89% following CD surgery. After surgery, 46% of patients visited a gastroenterologist within 6 months, which investigators defined as early postoperative gastrointestinal care (EPGIC).
Use of EPGIC varied according to region, and was correlated with the number of specialists within the regional network (P=.006). Patients receiving EPGIC were also more likely to be of a younger age at CD diagnosis (P<.001) and live in higher-income areas (P=.008).
EPGIC reduced the risk for postoperative hospitalization related to CD more than 1 year after the procedure (adjusted IRR=0.82, 95% CI, 0.72-0.94), but not overall (adjusted IRR=0.93, 95% CI, 0.83-1.04). Patients living in regions with more EPGIC use were less likely to be re-hospitalized for CD-related issues than those in areas with less utilization (adjusted IRR=0.83, 95% CI, 0.70-0.95).
Late hospitalization was associated with emergency visits within 6 months of hospitalization (adjusted IRR=2.60, 95% CI, 2.21-3.05), lower neighborhood income and more comorbidities. After adjusting for confounders, EPGIC utilization was not associated with emergency room visits within 6 months of surgery (adjusted HR=0.92, 95% CI, 0.79-1.07).
“Our study has demonstrated that surgery for CD leads to substantial and sustainable reductions in health-care utilization,” the researchers concluded. “… We have shown that early specialist care in the postoperative period has the potential to reduce the long-term risk of hospitalization. Consequently, we believe our findings justify consideration of randomized clinical trials to compare long-term surgical and hospitalization outcomes between those who receive EPGIC and standard of care.”
Disclosure: See the study for a full list of relevant financial disclosures.