Risk factors for initial surgery in pediatric patients with Crohn's disease

Background & Aims: The cumulative incidence of surgery ranges from 40%-70% at 10 years from the time of diagnosis of Crohn's disease in adults. We retrospectively determined the cumulative incidence of and risk factors for surgery (intestinal resection) in pediatric patients with Crohn's disease. Methods: Uniform data from 989 consecutive Crohn's disease patients (age 0-17 years at diagnosis), collected from 6 different pediatric centers between January 2000 and November 2003 and stored in the Pediatric IBD Consortium Registry, were analyzed. Results: Median follow-up time was 2.8 years (range, 1 day to 16.7 years). One hundred twenty-eight patients underwent surgery. Kaplan-Meier survival estimates of the cumulative incidence of surgery were 17% at 5 years and 28% at 10 years from the diagnosis of inflammatory bowel disease. Univariate Cox proportional hazards models showed leukocytosis (2.85 [hazard ratio]; P =.02), hypoalbuminemia (3.41; P =.05), and anti-Saccharomyces cerevisiae antibody (ASCA) positivity (3.43; P =.05) were associated with increased risk for surgery. Multivariate Cox models showed female gender (1.49; P =.03), initial diagnosis of ulcerative colitis (3.63; P <.0001), poor growth at presentation (2.16; P =.007), and abscess (1.90; P =.009), fistula (2.30; P =.0005), or stricture (3.41; P <.0001) development were associated with increased risk for surgery. Age 3-5 years (0.26; P =.01) or 6-12 years (0.62; P =.01) at diagnosis, fever at presentation (0.50; P =.03)7 and treatment with infliximab (0.36; P =.0005) or 5-aminosalicylic acid (0.44; P <.0001) were associated with decreased risk for surgery. Conclusion : Risk stratification during the course of Crohn's disease in pediatric patients will help to guide therapy that may improve the natural history of disease and decrease the need for surgery.