Risk factors and indications for first surgery in Crohn's disease patients

Background/Aims: Despite appropriate medical treatment, a large part of CD patients undergo surgery. In this study, we aimed to identify the risk factors and indications for first surgery in CD patients. Methodology: The clinical records of 289 consecutive Japanese CD patients treated at 23 hospitals between January 1981 and August 2003 were reviewed. Clinical factors, including gender, age at onset, year at onset, and disease extent were examined, in order to identify the risk factors for first surgery. In addition, indications for first surgery were investigated, and stratified by these risk factors. Results: A total of 113 (39%) patients underwent surgery at least once. Female gender (RR, 1.62; 95% Cl, 1.09-2.41), and disease affecting the ileum (RR, 2.06; 95% Cl, 1.20-3.53) were identified as the independent risk factors for surgery. In addition, female CD patients were more likely to undergo first surgery due to the indication of perforation than male patients (25% vs. 6%, p=0.006). Recent clinical and demographic changes of Japanese CD patients, such as increases in female and aged patients, did not affect the surgical risk factors and indications. Conclusions: Female CD patients should be consulted with special attention to the high risk of surgery due to perforation.