Abstract：
BACKGROUND: The era of biologics is associated with declining rates of surgery for Crohn\'s disease (CD), but the impact on surgery for stricturing CD is unknown. Our study aimed to assess nationwide trends in bowel resection surgery for obstruction in CD since the introduction of infliximab for CD in 1998.
METHODS: Using the Nationwide Inpatient Sample, we performed a nationwide analysis, identifying patients hospitalized for CD who underwent bowel resection for an indication of obstruction between 1998 and 2020 (era of biologics). Longitudinal trends in all CD-related resections and resection for obstruction were evaluated. Multivariable logistic regression identified patient and hospital characteristics associated with bowel resection surgery for obstruction.
RESULTS: Hospitalizations for all CD-related resections decreased from 12.0% of all hospitalizations in 1998 to 6.9% in 2020, while hospitalizations for CD-related resection for obstructive indication increased from 1.3% to 2.0%. The proportion of resections for obstructive indication amongst all CD-related bowel resections increased from 10.8% in 1998 to 29.1% in 2020. In the multivariable models stratified by elective admission, the increasing year was associated with risk of resection for obstructive indication regardless of urgency (nonelective model: odds ratio, 1.01; 95% CI, 1.00-1.02; elective model: odds ratio, 1.06; 95% CI, 1.04-1.08).
CONCLUSIONS: In the era of biologics, our findings demonstrate a decreasing annual rate of CD-related bowel resections but an increase in resection for obstructive indication. Our findings highlight the effect of medical therapy on surgical rates overall but suggest limited impact of current medical therapy on need of resection for stricturing disease.
In our nationwide analysis, rates of bowel resection for patients with Crohn’s disease have declined since the approval of infliximab in 1998. However, rates of resection for obstruction in patients with Crohn’s disease continue to increase.
METHODS: Using the Nationwide Inpatient Sample, we performed a nationwide analysis, identifying patients hospitalized for CD who underwent bowel resection for an indication of obstruction between 1998 and 2020 (era of biologics). Longitudinal trends in all CD-related resections and resection for obstruction were evaluated. Multivariable logistic regression identified patient and hospital characteristics associated with bowel resection surgery for obstruction.
RESULTS: Hospitalizations for all CD-related resections decreased from 12.0% of all hospitalizations in 1998 to 6.9% in 2020, while hospitalizations for CD-related resection for obstructive indication increased from 1.3% to 2.0%. The proportion of resections for obstructive indication amongst all CD-related bowel resections increased from 10.8% in 1998 to 29.1% in 2020. In the multivariable models stratified by elective admission, the increasing year was associated with risk of resection for obstructive indication regardless of urgency (nonelective model: odds ratio, 1.01; 95% CI, 1.00-1.02; elective model: odds ratio, 1.06; 95% CI, 1.04-1.08).
CONCLUSIONS: In the era of biologics, our findings demonstrate a decreasing annual rate of CD-related bowel resections but an increase in resection for obstructive indication. Our findings highlight the effect of medical therapy on surgical rates overall but suggest limited impact of current medical therapy on need of resection for stricturing disease.
In our nationwide analysis, rates of bowel resection for patients with Crohn’s disease have declined since the approval of infliximab in 1998. However, rates of resection for obstruction in patients with Crohn’s disease continue to increase.
摘要：
背景：生物制剂时代与克罗恩病（CD）手术率下降有关，但对狭窄CD手术的影响尚不清楚。我们的研究旨在评估自1998年引入英夫利昔单抗治疗CD以来，全国范围内肠切除术治疗CD梗阻的趋势。
方法：使用全国住院患者样本，我们进行了全国性的分析，在1998年至2020年(生物制剂时代)期间,确定因梗阻而接受肠切除术的CD住院患者.评估了所有CD相关切除和梗阻切除的纵向趋势。多变量逻辑回归确定了与肠梗阻切除手术相关的患者和医院特征。
结果：所有CD相关切除术的住院率从1998年的12.0％下降到2020年的6.9％，而CD相关切除术的阻塞性适应症的住院率从1.3％上升到2.0％。在所有CD相关肠切除术中，阻塞性适应症的切除比例从1998年的10.8％增加到2020年的29.1％。在按择期录取分层的多变量模型中，与紧迫性无关，增加的年份与阻塞性适应症的切除风险相关(非选择性模型：比值比，1.01；95%CI，1.00-1.02；选修模型：赔率比，1.06；95%CI，1.04-1.08）。
结论：在生物制品时代，我们的研究结果表明,与CD相关的肠切除术的年发生率在下降,但对于阻塞性适应症的切除术却在增加.我们的发现强调了药物治疗对整体手术率的影响，但表明当前药物治疗对狭窄疾病切除需求的影响有限。
在全国范围的分析中,自1998年英夫利昔单抗获得批准以来,克罗恩病患者的肠切除率有所下降.然而,克罗恩病患者的梗阻切除率继续增加。
方法：使用全国住院患者样本，我们进行了全国性的分析，在1998年至2020年(生物制剂时代)期间,确定因梗阻而接受肠切除术的CD住院患者.评估了所有CD相关切除和梗阻切除的纵向趋势。多变量逻辑回归确定了与肠梗阻切除手术相关的患者和医院特征。
结果：所有CD相关切除术的住院率从1998年的12.0％下降到2020年的6.9％，而CD相关切除术的阻塞性适应症的住院率从1.3％上升到2.0％。在所有CD相关肠切除术中，阻塞性适应症的切除比例从1998年的10.8％增加到2020年的29.1％。在按择期录取分层的多变量模型中，与紧迫性无关，增加的年份与阻塞性适应症的切除风险相关(非选择性模型：比值比，1.01；95%CI，1.00-1.02；选修模型：赔率比，1.06；95%CI，1.04-1.08）。
结论：在生物制品时代，我们的研究结果表明,与CD相关的肠切除术的年发生率在下降,但对于阻塞性适应症的切除术却在增加.我们的发现强调了药物治疗对整体手术率的影响，但表明当前药物治疗对狭窄疾病切除需求的影响有限。
在全国范围的分析中,自1998年英夫利昔单抗获得批准以来,克罗恩病患者的肠切除率有所下降.然而,克罗恩病患者的梗阻切除率继续增加。
