Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada.
Am J Gastroenterol. 2012 Oct;107(10):1522-9. doi: 10.1038/ajg.2012.235. Epub 2012 Jul 31.
Crohn's disease (CD) patients frequently require surgery. We sought to characterize postoperative health-care utilization and its impact on outcomes.
We assembled a population-based cohort of CD patients who underwent first surgery in Ontario, Canada, between 1996 and 2009. We compared intra-individual preoperative and postoperative health-care utilization and characterized utilization of early postoperative gastrointestinal care (EPGIC) and its impact on health outcomes.
For the 2,943 CD patients who underwent surgery, the 5-year risk of recurrent surgery was 26%. In the 5th postoperative year, the average annual number of inflammatory bowel disease (IBD)-related clinic visits, emergency department visits, endoscopy procedures, radiological procedures, and hospitalizations decreased by 62, 62, 82, 78, and 89% compared with prior to surgery. Regional utilization of EPGIC varied between 18 and 62% and correlated with the number of gastroenterologists within a regional local health integration network (ρ=0.71; P=0.006). EPGIC was associated with reduced risk of late postoperative CD-related hospitalizations (at least 1 year after surgery; adjusted incidence ratio (IRR), 0.82; 95% confidence interval (CI): 0.72-0.94). Other predictors of late hospitalizations included having an emergency department visit within 6 months (adjusted IRR, 2.60; 95% CI: 2.21-3.05), lower income, and higher comorbidity. Individuals residing in regions with high aggregate EPGIC utilization experienced lower rates of hospitalization compared with those in regions with low utilization (adjusted IRR, 0.83; 95% CI: 0.70-0.95).
IBD-related health-care utilization decreased significantly up to 5 years following surgery. EPGIC may reduce late CD-related hospitalizations following surgery.
克罗恩病（CD）患者经常需要手术。我们旨在描述术后医疗保健的利用情况及其对结局的影响。
我们组建了一个基于人群的 CD 患者队列，这些患者于 1996 年至 2009 年间在加拿大安大略省接受了首次手术。我们比较了个体患者的术前和术后医疗保健利用情况，并描述了早期术后胃肠病学护理（EPGIC）的利用情况及其对健康结局的影响。
对于 2943 名接受手术的 CD 患者，术后 5 年内再次手术的风险为 26%。在术后第 5 年，与术前相比，IBD 相关的就诊次数、急诊就诊次数、内镜检查次数、影像学检查次数和住院次数分别减少了 62%、62%、82%、78%和 89%。区域 EPGIC 的利用情况在 18%至 62%之间变化，且与区域内胃肠病学家数量相关（ρ=0.71；P=0.006）。EPGIC 与术后晚期 CD 相关住院率降低相关（术后至少 1 年；校正后的发病率比（IRR）为 0.82；95%置信区间（CI）：0.72-0.94）。晚期住院的其他预测因素包括术后 6 个月内急诊就诊（校正 IRR，2.60；95%CI：2.21-3.05）、较低的收入和更高的合并症。与低利用地区相比，EPGIC 综合利用率高的地区的个体住院率较低（校正 IRR，0.83；95%CI：0.70-0.95）。
手术治疗后，IBD 相关的医疗保健利用率显著下降。EPGIC 可能会降低术后晚期 CD 相关的住院率。
