A multivariate analysis of risk factors associated with recurrence following surgery for Crohn's disease

The aim of this study was to identify risk factors associated with the recurrence of Crohn's disease (CD) after definitive surgery.

A retrospective review was conducted on 228 patients with histologically proven CD who had undergone surgery to remove macroscopic disease. Recurrence was defined as the requirement to undergo further surgery for symptomatic CD. Logistic linear regression was used to evaluate the relationship between 16 independent variables and the incidence of recurrent disease.

The male to female ratio was 1:1.3, the mean age at operation was 32 years (range 11-93 years), and the patients were followed post-operatively for a mean of 58 months (range 1-396 months). Survival analysis found that 29.2% of patients had a recurrence of CD at 5 years, and 46.0% at 10 years. Univariate analysis identified the following factors which were significant predictors for recurrence-an abscess as an indication for surgery, the absence of Mesalazine/Sulphasalazine therapy in the preoperative period, length of follow up, development of post-operative septic complications (abscess, anastomotic leak, fistula formation), and the presence of anal disease (perianal fistula, abscess, rectovaginal fistula, anal ulceration). The only significant independent predictors for recurrence were follow-up time (P=0.04, odds ratio (OR) 1.01, 95% confidence interval (CI) 1.00-1.01) and the absence of preoperative Mesalazine/Sulphasalazine therapy (P=0.05, OR 2.02, 95% CI 0.99-4.13).

The results suggest that the use of Mesalazine/Sulphasalazine before surgery influenced the subsequent recurrence of CD. The clinical relevance of this observation requires further validation.