Abstract
Background: Despite therapeutic advances, a significant proportion of people with Crohn’s disease (CD) continue to receive surgical intervention. International data suggest that approximately 18% and 26% of patients undergo surgery within five and ten years of diagnosis, respectively.1 Here rates of bowel resection and possible predictors are explored in a large Australian and New Zealand cohort using the Crohn’s Colitis Care (CCCare) Clinical Quality Registry.
Methods: CCCare is a cloud-based IBD-specific electronic medical record used in Australia and New Zealand, feeding into a de-identified registry. Data were extracted in February 2025 from individuals with CD reviewed in the previous fourteen months. Variables collected included demographics, disease phenotype, extra-intestinal manifestations (EIMs), treatment history, and history of bowel resection. Multivariate regression and Cox proportional hazards models were used to identify predictors of bowel resection. Poisson incidence rate analysis assessed resection rates across disease duration in five-year intervals.
Results: Data on 3,790 individuals with CD revealed a median age of 42.9 (32.3 – 58.0) years with even sex distribution. Median age at diagnosis was 24.9 (17.5 – 36.6) years. Extra-intestinal manifestations were present in 21.1%. Bowel resection was documented in 22.5% (n=855), 77% being small bowel resections. Female sex and stricturing or penetrating disease were associated with an increased risk of bowel resection, whereas ASA use was associated with a lower risk (Table 1). Patients with ileal or ileo-colonic disease had a higher resection risk compared to those with isolated colonic disease (Figure 1). Bowel resection rate was the highest in the first five years following diagnosis with a rate of 0.152 resections per person-year (95% CI: 0.137 – 0.169).
Conclusion: Bowel resection remains an important management approach in CD, with over 20% of patients in this cohort requiring resection. Demographic and clinical factors, notably sex, disease location and behaviour, were associated with risk of surgery. These findings may improve risk stratification and inform a more tailored treatment approach.