Is early limited surgery associated with a more benign disease course in Crohn’s disease?

Table 1 Clinical characteristics of patients with Crohn’s disease

Characteristics	n = 506
Male/female	251/255
Age at presentation (yr)	31.5 ± 13.8
Median follow-up (yr)	11.4 ± 7.8
Familial IBD	12.9%
Location (n)
L1	166
L2	182
L3	155
L4 only	3
Behavior (n)
B1	288
At diagnosis B2	100
B3	118
Perianal disease	25.5%
Total steroid exposure/dependent-refractory	68.6%/11.2%
Total azathioprine exposure	45.8%
Total biological exposure	9.1%
Smoking habits (n)
No	224
At diagnosis Ex	38
Yes	244

L1: Ileal; L2: Colonic; L3: Ileocolonic; L4: Upper Gastrointestinal; B1: Inflammatory; B2: Stenosing; B3: Penetrating. IBD: Inflammatory bowel disease.

Table 2 Predictors of early limited surgery and drug exposures

	Early surgery	No early surgery	P value	OR (95%CI)
Age at onset (A1)	28.4%	19.0%	0.060	1.69 (0.97-2.96)
Ileal location	59.5%	28.1%	< 0.001
Colonic location	13.5%	39.9%	< 0.001
Complicated behavior at diagnosis	85.1%	35.9%	< 0.001	10.2 (5.2-20.1)
Overall steroid exposure	52.7%	71.3%	0.001	0.45 (0.27-0.74)
Steroid-dependent course	2.6%	12.3%	0.070	0.19 (0.03-1.40
Overall biological exposure	4.1%	10.0%	0.090	0.38 (0.12-1.26)
Overall azathioprine exposure	45.9%	45.8%	> 0.050

Table 3 Factors associated with the need for early limited surgery in logistic regression analysis

	P value	OR	95%CI
Age at diagnosis
A1	0.172	1.62	0.81-3.25
A2	Reference
Disease location	< 0.001
L1	< 0.001	7.88	2.92-21.3
L3	0.035	3.21	1.09-9.48
L2	Reference
Disease behavior at diagnosis	< 0.001
B2	< 0.001	4.91	2.15-11.2
B3	< 0.001	7.66	3.52-16.7
B1	Reference
Smoking
Yes	0.487	1.24	0.68-2.27
No	Reference

L1: Ileal; L2: Colonic; L3: Ileocolonic; B1: Inflammatory; B2: Stenosing; B3: Penetrating.

Table 4 Characteristics of patients with and without early resective surgery after matching on propensity scores

	CD patient with early surgery (n = 58)	CD patient without early surgery (n = 58)1
Gender (male/female)	32/26	34/24
Age at onset below 40 yr	12	11
Decade of diagnosis
1977-1989	8	9
1990-1999	22	23
2000-2008	28	26
Disease location
L1	38	39
L32	20	19
Disease behavior at diagnosis
B1	10	10
B2	20	19
B3	28	29
Smoking (yes/no)	36/22	35/23

¹Early resective surgery: within the year of diagnosis;

²Ileocecal. CD: Crohn’s disease; L1: Ileal; L2: Colonic; L3: Ileocolonic; B1: Inflammatory; B2: Stenosing; B3: Penetrating.

Table 5 Factors associated with the need for reoperation in Cox regression analysis

	P value	HR	95%CI
Early surgery1
Yes	0.04	0.42	0.19-0.95
No	Reference
Age at diagnosis
A1	0.75	-	-
A2	Reference
Disease location	0.95
L2	0.77	-	-
L3	0.95	-	-
L1	Reference
Disease behavior at diagnosis	0.56
B2	0.30	-	-
B3	0.65	-	-
B1	Reference
Smoking
Yes	0.29	-	-
No	Reference

¹Early resective surgery: Within the year of diagnosis.