Journal
INFLAMMATORY BOWEL DISEASES
Volume 27, Issue 7, Pages 1035-1044Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ibd/izaa239
Keywords
Crohn's disease; biologics; surgery; pediatrics; natural language processing
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Funding
- Celgene Corporation
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This study utilized natural language processing and codified data to analyze surgical rates and medication usage among patients with Crohn's disease, revealing significant differences between pediatric and adult-onset cohorts, with biologics treatment associated with lower surgery rates.
Background and Aims: Crohn's disease (CD) is a chronic illness that affects both the pediatric and adult populations with an increasing worldwide prevalence. We aim to identify a large, single-center cohort of patients with CD using natural language processing (NLP) in combination with codified data and extract surgical rates and medication usage from the electronic medical record (EMR). Methods: Patients with CD were identified from the entire Cleveland Clinic EMR using ICD codes and CD-specific terms identified by NLP to fit a logistic regression model. Cohorts were developed for pediatric-onset (younger than 18 years) and adult-onset (18 years and older) CD. Surgeries were identified using current procedural terminology (CPT) codes and NLP. Crohn's disease-related medications were extracted using physician orders in the EMR. Results: Patients with pediatric-onset (n = 2060) and adult-onset (n = 4973) CD were identified from 2000 to 2017 with a positive predictive value of 98.5%. Rate of CD-related abdominal surgery over time was significantly higher in adult-onset compared with pediatric-onset CD (10-year surgery rate 49.9% vs 37.7%, respectively; P < 0.001). Treatment with biologics was significantly higher in pediatric vs adult-onset CD cohorts (63.6% vs 49.2%; P < 0.001). The overall rate of CD-related abdominal surgery was significantly higher in those who received <6 months of a biologic compared with >= 6 months of a biologic for both cohorts (pediatric 64.1% vs 39.1%, P <= 0.001; adult 69.3% vs 56.5%, P <= 0.001). Additionally, 60.9% in pediatric-onset CD and 43.5% in adult-onset CD treated with >= 6 months of biologic therapy have not required abdominal surgery. On multivariable analysis, perianal surgery was a significant risk factor for abdominal surgery in both cohorts. Conclusion: We used a combination of codified and NLP data to establish the largest, North American, single-center EMR cohort of pediatric- and adult-onset CD patients and determined that biologics are associated with lower rates of surgery over time, potentially altering the natural history of the disease.
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