Ma Christopher, Moran Gordon W, Benchimol Eric I, Targownik Laura E, Heitman Steven J, Hubbard James N, Seow Cynthia H, Novak Kerri L, Ghosh Subrata, Panaccione Remo, Kaplan Gilaad G
Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
National Institute of Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust and the University of Nottingham, Queens Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Am J Gastroenterol. 2017 Dec;112(12):1840-1848. doi: 10.1038/ajg.2017.394. Epub 2017 Oct 31.
Temporal changes for intestinal resections for Crohn's disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.
First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections. Second, we used these validated codes to conduct population-based surveillance between fiscal years 2002 and 2010 to identify adult CD patients undergoing intestinal resection (n=981). Annual surgical rate was calculated by dividing incident surgeries by estimated CD prevalence. Time trend analysis was performed and annual percent change (APC) with 95% confidence intervals (CI) in surgical resection rates were calculated using a generalized linear model assuming a Poisson distribution.
In the validation cohort, 101/104 (97.1%) patients undergoing surgery and 191/200 (95.5%) patients admitted without surgery were confirmed to have CD on chart review. Among the 116 administrative database codes for surgical resection, 97.4% were confirmed intestinal resections on chart review. From 2002 to 2010, the overall CD surgical resection rate was 3.8 resections per 100 person-years. During the study period, rate of surgery decreased by 3.5% per year (95% CI: -1.1%, -5.8%), driven by decreasing emergent operations (-10.1% per year (95% CI: -13.4%, -6.7%)) whereas elective surgeries increased by 3.7% per year (95% CI: 0.1%, 7.3%).
Overall surgical resection rates in CD are decreasing, but a paradigm shift has occurred whereby elective operations are now more commonly performed than emergent surgeries.
克罗恩病（CD）肠道切除术的时间变化存在争议。我们验证了住院患者中CD诊断和手术的管理数据库编码，然后评估了CD手术切除率的时间趋势。
首先，我们验证了国际疾病分类（ICD）-10-CM编码用于住院患者的CD诊断以及加拿大健康干预分类编码用于手术切除。其次，我们使用这些经过验证的编码在2002财年至2010财年期间进行基于人群的监测，以识别接受肠道切除术的成年CD患者（n = 981）。通过将新发手术数除以估计的CD患病率来计算年手术率。进行了时间趋势分析，并使用假设泊松分布的广义线性模型计算手术切除率的年度百分比变化（APC）及其95%置信区间（CI）。
在验证队列中，经病历审查确认，104例接受手术的患者中有101例（97.1%）以及200例未接受手术入院的患者中有191例（95.5%）患有CD。在116个手术切除的管理数据库编码中，经病历审查97.4%被确认为肠道切除术。从2002年到2010年，CD总体手术切除率为每100人年3.8例切除术。在研究期间，手术率每年下降3.5%（95% CI：-1.1%，-5.8%），这是由急诊手术减少（每年-10.1%（95% CI：-13.4%，-6.7%））驱动的，而择期手术每年增加3.7%（95% CI：0.1%，7.3%）。
CD的总体手术切除率正在下降，但已经发生了一种模式转变，即现在择期手术比急诊手术更常见。
