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Interval of less than 5 years between the first and second operation is a risk factor for a third operation for
Toshiaki Watanabe1, Iwao Sasaki, Akira Sugita
1Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan. toshwatanabe@yahoo.co.jp
Background:
Previous studies have shown various risk factors for the initial and/or the second operation for Crohn's disease (CD). However, limited data are available with regard to the risk factors for a third operation. We aimed to clarify the risk factors for a third operation for CD.
Methods:
A total of 200 CD patients who underwent a second intestinal surgery at 13 institutions were examined. We performed univariate and multivariate analyses to examine the influence of independent variables on the cumulative rate of needing a third operation.
Results:
A total of 95 patients underwent a third operation. The overall 5-year and 10-year cumulative rates for the third operation were 42.2% and 71.0%, respectively. In univariate analysis, the interval between the initial and the second operation (P = 0.0069), postoperative administration of infliximab (P = 0.0030), and the anatomical site of the disease (P = 0.0132) were significant risk factors for the third operation. In multivariate analysis, the interval between the initial and the second operation (P = 0.0287) and postoperative administration of infliximab (P = 0.0297) remained significant risk factors for the third operation. The cumulative 5-year third operation rate was significantly higher in patients with an interval of less than 5 years between the first and second operations than for those with an interval of 5 years or more (47.8% versus 35.2%, P = 0.0232).
Conclusions:
An interval of less than 5 years between the first and the second operations is a significant risk factor for a third operation in patients with CD.
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