Comparative Study on the Management and Outcomes of Postoperative Crohn's Disease in Older Patients: Data From the ENEIDA Registry.
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Mañosa Míriam, Calafat Margalida, Ricart Elena, Nos Pilar, Iglesias Eva, Riestra Sabino, Mesonero Francisco, Calvo Marta, Guardiola Jordi, Hernández Vicent, Rivero Montserrat, Carpio Daniel, Mínguez Miguel, Alba Cristina, Martín-Arranz Maria Dolores, Vela Milagros, Gomollón Fernando, García-López Santiago, Casbas Ana Gutiérrez, Calvet Xavier, González-Muñoza Carlos, Barrio Jesús, Gisbert Javier P, Sicilia Beatriz, Pérez-Calle José Lázaro, Bujanda Luis, Esteve Maria, Ramos Laura, Varela Pilar, Sierra Mónica, Merino Olga, Bermejo Fernando, Barreiro-de Acosta Manuel, Perez Antonio Rodríguez, Márquez-Mosquera Lucía, García-Bosch Orlando, Rodríguez-Lago Iago, Lorente Poyatos Rufo H, García Sepulcre Mariana Fe, Maroto Nuria, Vega Pablo, Monfort David, San Martín Lucía Zabalsa, Busquets David, Martinez-Montiel Pilar, Riera Joan, Alcain Guillermo, Llaó Jordina, Marin Nacho, Marin-Jimenez Ignacio, Sesé Eva, Van Domselaar Manuel, Huguet José M, Ginard Daniel, Bas-Cutrina Francesc, Ber Yolanda, Roncero Oscar, Lucendo Alfredo J, López-García Alicia, Menacho Margarita, Almela Pedro, Ponferrada Ángel, Coronel Ana Fuentes, Maestro Sergio, de Jesús Martínez-Pérez Teresa, Vilafranca Carmen Muñoz, Argüelles Federico, Legido Jesús, Gilabert Pau, Charro Mara, Trapero Ana M, Fernández Hipólito, Frago Santiago, Villalba Luis Hernández, Muñoz Esther, Domènech Eugeni, ENEIDA registry of GETECCU
Аннотация
METHODS: This was a case-control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo-colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).
RESULTS: A total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo-colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.
CONCLUSIONS: Although postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.