DOP104 International differences in pre-operative characteristics and postoperative management in patients with Crohn’s disease following ileocolic resection: a report from the IMPACT consortium
Authors: Bak M , Hammoudi N , Maggiori L , van Ruler O , Hernandez-Rocha C , de Vries A , Silverberg M , Allez M 
Published: January 2025

Background

Intestinal surgery is a key treatment for Crohn’s disease (CD). Large cohort data on perioperative management are vital to improve postoperative outcomes. This study aimed to assess and compare preoperative characteristics and postoperative management across three large prospective cohort studies of CD patients following ileocolic resection (ICR).

Methods

The IMPACT consortium (International Multidisciplinary Research Collaboration on Postoperative IBD) is an intercontinental initiative focused on postoperative inflammatory bowel disease research. Prospective data were used from three ongoing cohort studies with a comparable set-up and data collection, including CD patients who underwent ICR between December 2009 and September 2024, originating from the Netherlands (NL), North-America (Canada [CAN] and United States of America [USA]) and France (FR). Pre-operative characteristics, clinical risk profiles for post-operative recurrence (POR), use of postoperative prophylactic medication and performance of endoscopic evaluation were compared between the involved countries.

Results

1,601 patients with CD following ICR were included (455 NL, 149 CAN, 307 USA, 690 FR)(48.3% male; median age at surgery 33.7 years [IQR 25.8-46.6])(Table 1). Active smoking rates were higher in Europe (NL: 26.2%; FR: 32.8%) compared with North America (CAN: 13.2%; USA: 8.2%). Prior small bowel resections were more common in North American (CAN: 29.5%; USA: 27.0%) compared with Europe (NL: 20.0%; FR: 17.0%). Preoperative biological exposure was lower in Canada (55.7%) and the USA (56.0%) compared with the Netherlands (69.2%) and France (75.5%). A higher proportion of Dutch patients had non-complicated CD (Montreal B1) at surgery (18.4%) compared to other countries (CAN: 1.4%; USA: 2.3%; FR: 4.5%). Overall, 72.7% were considered high-risk for POR, with the lowest rates in the Dutch cohort (62.2%) compared to the other countries (CAN: 73.8%; USA: 77.9%; FR: 77.1%).

Postoperative prophylactic medication was initiated in 42.2% with higher rates in the USA (45.9%) and France (51.0%) compared with the Netherlands (28.5%) and Canada (34.9%). Details on postoperative prophylactic medication use are provided in Table 2. An endoscopic evaluation within one year postoperatively was performed in 89.0% of patients, with higher rates (&gt;85%) in the Netherlands, Canada, and France, compared with the USA (66.9%).

Conclusion

This first study of the IMPACT consortium revealed notable differences in preoperative characteristics, risk profiles for postoperative recurrence, use of prophylactic medication, and postoperative endoscopic evaluation across Europe and North America. Further analyses will include the assessment of rates and factors associated with endoscopic recurrence.

References

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2.Lamb CA, Kennedy NA, Raine T, et al. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut. 2019;68:s1–s106.