Gastro Hep Advances (Jan 2022)
Postoperative Use of Biologics Was Less Common Among Patients With Crohn’s Disease With Emergent/Urgent vs Elective Intestinal Resection
Abstract
Background and Aims: Given the risk of intestinal resection for Crohn’s disease, postoperative treatment may be informed by several risk factors, including resection type. We compared postoperative treatment strategies for Crohn’s disease between emergent/urgent vs elective resection. Methods: We identified patients with intestinal resection for Crohn’s disease between 2002 and 2018 using the MarketScan databases. We classified emergent/urgent resections as those occurring after emergency department admission or after the second day of admission. We estimated adjusted risk differences for the association between resection type (emergent/urgent vs elective) and 6-month postoperative medication strategy (biologic monotherapy, biologic combination therapy with an immunomodulator, immunomodulator monotherapy, other nonbiologic medication for Crohn’s [5-aminosalicylates, antibiotics, and corticosteroids], or no medications for Crohn’s). Results: During 6 months after resection among 4187 patients, 23% received biologic monotherapy, 6% received combination therapy, 16% received immunomodulator monotherapy, and 36% received other nonbiologics. Compared with elective resection, emergent/urgent resection was associated with more common use of “other nonbiologic” medications (risk difference 6.4%; 95% confidence interval [CI] 2.8%, 10.0%), but less common use of biologic monotherapy (risk difference −3.2%; 95% CI −6.2%, −0.1%) and no medications (risk difference −3.6%; 95% CI −6.6%, −0.6%). Conclusion: Although patients with emergent/urgent resection may benefit from more aggressive postoperative therapy, there was evidence that emergent/urgent resection was more associated than elective resection with postoperative use of nonbiologics for Crohn’s disease. Future studies of treatment patterns and comparative effectiveness of postoperative treatment strategies for Crohn’s patients should consider these differences between resection types, which may be important drivers of longer term outcomes.
