Risk factors for stricture-related surgery in stricturing Crohn's disease

Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, frequently complicated by stricture, fistula, and abscess. Strictures affect nearly 50% of patients, often requiring medical, endoscopic, or surgical management. This study aimed to identify surgical risk factors and postoperative complications in CD patients with strictures.

Patients with stricturing CD followed at our inflammatory bowel disease (IBD)- specific outpatient clinic between 1989 and 2024 were retrospectively analyzed. Clinical data were collected from hospital records. Patients were categorized based on the history of CD-related surgery. Risk factors for surgery and 90-day postoperative complications were assessed.

A total of 128 patients were included (mean ± standard deviation (SD) age 40.3 ± 14.2 years; 45.3% female). ​​Prior biologic therapy was significantly more common among surgical patients (87.5% vs. 36.4%, p = 0.003). Ileocolonic involvement was associated with a significantly higher surgical rate compared to isolated ileal disease (p = 0.008). The median disease duration was 9 years (1-43) in the surgical group and 6 years (0-17) in the non-surgical group (p = 0.0001). Multivariable analysis identified disease duration (p = 0.005, OR = 1.112) and biologic use (p = 0.043, OR = 2.749) as independent predictors. Postoperative complications occurred in 36.1% of surgical patients, with no significant risk factors identified.

Longer disease duration and prior biologic therapy were independently associated with increased surgical risk, likely reflecting more severe disease. Moreover, extended disease duration may contribute to the development of complications such as strictures, thereby increasing the need for surgery, especially in patients with more aggressive disease phenotypes.