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Specialist care influences postoperative health-care use in Crohn's disease

The latest issue of the American Journal of Gastroenterology investigates the impact of specialist care on postoperative health-care utilization in Crohn's disease.

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Crohn's disease patients frequently require surgery.

Dr Nguyen and colleagues from Maryland, USA characterized postoperative health-care utilization, and its impact on outcomes.

The researchers assembled a population-based cohort of Crohn's disease patients who underwent first surgery in Ontario, Canada, between 1996 and 2009.

The team compared intra-individual preoperative and postoperative health-care utilization, and characterized utilization of early postoperative gastrointestinal care, and its impact on health outcomes.

For the 2,943 Crohn's disease patients who underwent surgery, the research team observed that the 5-year risk of recurrent surgery was 26%.

The 5-year risk of recurrent surgery was 26%
American Journal of Gastroenterology

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.

The team noted that the regional utilization of early postoperative gastrointestinal care varied between 18% and 62% and correlated with the number of gastroenterologists within a regional local health integration network.

The researchers found that early postoperative gastrointestinal care was associated with reduced risk of late postoperative Crohn's disease-related hospitalizations.

Other predictors of late hospitalizations included having an emergency department visit within 6 months, lower income, and higher comorbidity.

The team observed that individuals residing in regions with high aggregate early postoperative gastrointestinal care utilization experienced lower rates of hospitalization compared with those in regions with low utilization.

Dr Nguyen's team concludes, "IBD-related health-care utilization decreased significantly up to 5 years following surgery."

"Early postoperative gastrointestinal care may reduce late Crohn's disease-related hospitalizations following surgery."

Am J Gastroenterol 2012: 107(10): 1522-9
11 October 2012

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