Older age not linked to increased risk for Crohn’s recurrence after surgical resection
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SAN DIEGO — The risk for postoperative recurrence of Crohn’s disease after ileocolic resection did not increase among older patients compared with a younger cohort, according to research presented at Digestive Disease Week 2022.
“Despite the advances of medical therapy, the need for surgical intervention [for CD] is still quite significant with more recent estimates placing the 10-year risk for surgery at around 25%. ... As we know from the PREVENT trial and other studies, [anti-tumor necrosis factor] and presumably other post-op biologics reduce the risk of endoscopic recurrence,” Jessica El Halabi, MD, resident physician at the Cleveland Clinic, said. “However, when we take a closer look at individuals with Crohn's disease, particularly older adults, we see that there is a much lower utilization of immunomodulators and biologic therapies in this special patient population. ... The data of post operative recurrence rates and the role of medical therapy in this special patient population is largely unknown.”
In a retrospective study, Halabi and colleagues evaluated 824 patients with CD from a large health care system who underwent ileocolic resection between 2009 and 2020. They matched patients aged 60 years and older with younger patients (< 60 years) by preoperative recurrence risk factors to compare rates of radiologic, endoscopic, surgical and composite recurrence at 1 year, 3 years and 5 years.
Risk factor comparison revealed that older CD patients had lower proportions of active smokers (17% vs. 24%), incidences of intraabdominal penetrating disease (43% vs. 55%) and younger age at diagnosis (< 30 years: 29% vs. 78%) but a higher proportion who underwent at least two prior surgeries for CD (30% vs. 17%).
Researchers observed radiographic recurrence among 28% of patients (33% young vs. 20% old), endoscopic recurrence among 44% of patients (46% vs. 40%) and surgical recurrence among 13% of patients (16% vs. 9%) after 5 years. Compared with their younger counterparts, older adults with CD had lower rates of radiographic recurrence at 1 year (HR = 0.337; 95% CI, 0.121-0.938) and 3 years (HR = 0.491; 95% CI, 0.245-0.986) but no difference was observed after 5 years.
Further, sensitivity analyses among patients who underwent imaging studies (n = 129) and endoscopic procedures (n = 177) revealed no difference in recurrence between age groups.
“Crude rates suggest slightly higher recurrence in the younger population given that they have more risk factors, but chronologic age was not independently associated with recurrence in matched analysis,” El Halabi concluded. “Older adult patients remain at risk for postoperative recurrence and should be appropriately risk stratified for postoperative management.”
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El Halabi J, et al. Abstract 456. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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