Journal
AMERICAN JOURNAL OF GASTROENTEROLOGY
Volume 107, Issue 10, Pages 1522-1529Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ajg.2012.235
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Funding
- Canadian Institutes of Health Research (CIHR)
- Canadian Association of Gastroenterology
- Crohn's and Colitis Foundation of Canada
- CIHR
- Institute for Clinical Evaluative Sciences (ICES)
- Ontario Ministry of Health and Long-Term Care (MOHLTC)
- IBD Research Fund at Sunnybrook Hospital
- Division of Gastroenterology at Mount Sinai Hospital
- Merck
- Abbott
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OBJECTIVES: Crohn's disease (CD) patients frequently require surgery. We sought to characterize postoperative health-care utilization and its impact on outcomes. METHODS: We assembled a population-based cohort of CD patients who underwent first surgery in Ontario, Canada, between 1996 and 2009. We compared intra-individual preoperative and postoperative health-care utilization and characterized utilization of early postoperative gastrointestinal care (EPGIC) and its impact on health outcomes. RESULTS: For the 2,943 CD patients who underwent surgery, the 5-year risk of recurrent surgery was 26%. In the 5th postoperative year, the average annual number of inflammatory bowel disease (IBD)-related clinic visits, emergency department visits, endoscopy procedures, radiological procedures, and hospitalizations decreased by 62, 62, 82, 78, and 89% compared with prior to surgery. Regional utilization of EPGIC varied between 18 and 62% and correlated with the number of gastroenterologists within a regional local health integration network (rho = 0.71; P = 0.006). EPGIC was associated with reduced risk of late postoperative CD-related hospitalizations (at least 1 year after surgery; adjusted incidence ratio (IRR), 0.82; 95% confidence interval (CI): 0.72-0.94). Other predictors of late hospitalizations included having an emergency department visit within 6 months (adjusted IRR, 2.60; 95% CI: 2.21-3.05), lower income, and higher comorbidity. Individuals residing in regions with high aggregate EPGIC utilization experienced lower rates of hospitalization compared with those in regions with low utilization (adjusted IRR, 0.83; 95 % CI: 0.70-0.95). CONCLUSIONS: IBD-related health-care utilization decreased significantly up to 5 years following surgery. EPGIC may reduce late CD-related hospitalizations following surgery.
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