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Vavricka, Stephan R.; Greuter, Thomas; Brüngger, Beat; Blozik, Eva; Celeiro, Jennifer; Schoepfer, Alain M.; Bähler, Caroline

Follow-Up Ileocolonoscopy Is Underused in Crohn’s Disease Patients after Ileocecal Resection despite Higher Total and Inpatient Health-Care Costs Compared to Controls

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  • Media type: E-Article
  • Title: Follow-Up Ileocolonoscopy Is Underused in Crohn’s Disease Patients after Ileocecal Resection despite Higher Total and Inpatient Health-Care Costs Compared to Controls
  • Contributor: Vavricka, Stephan R.; Greuter, Thomas; Brüngger, Beat; Blozik, Eva; Celeiro, Jennifer; Schoepfer, Alain M.; Bähler, Caroline
  • imprint: S. Karger AG, 2020
  • Published in: Inflammatory Intestinal Diseases, 5 (2020) 3, Seite 100-108
  • Language: English
  • DOI: 10.1159/000507115
  • ISSN: 2296-9403; 2296-9365
  • Keywords: Gastroenterology
  • Origination:
  • Footnote:
  • Description: <jats:p>&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Postoperative recurrence is frequently observed after ileocecal resection in Crohn’s disease (CD) patients. Since 2010, endoscopy within 1 year is considered the gold standard for its diagnosis. However, if and how frequent such endoscopies are performed in clinical practice remains unknown. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; We analyzed 1-year follow-up data on CD patients who underwent ileocecal resection between 2012 and 2014 and compared them with hospitalized, non-resected CD controls. Data were extracted from the Helsana database. Helsana is one of the largest Swiss health insurance companies providing coverage for 1.2 million individuals. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A total of 645 CD patients were identified with ≥1 hospitalization between 2012 and 2014 and a follow-up of 1 year. Of these, 79 (12.2%) underwent ileocecal resection. Although endoscopy rates increased over time and were higher in patients with resection versus controls (&lt;i&gt;p&lt;/i&gt; = 0.029), in only 54.4% a 1-year follow-up ileocolonoscopy was performed. Postoperative prophylaxis with anti-tumor necrosis factor or azathioprine was prescribed in 63.3%. Female sex and age &amp;#x3e;60 years were independent predictors for not receiving prophylaxis (odds ratio [OR] 0.36, &lt;i&gt;p&lt;/i&gt; = 0.048, and OR 0.2, &lt;i&gt;p&lt;/i&gt; = 0.022). Patients with resection had significantly lower numbers of rehospitalizations (1.2 vs. 1.8, &lt;i&gt;p&lt;/i&gt; = 0.021), with resection being an independent negative predictor for number of rehospitalizations in a Poisson regression model (incident risk ratio 0.64, &lt;i&gt;p&lt;/i&gt; = 0.029). However, disease-related surgery was more often the cause for rehospitalization after resection versus controls (47.6 vs. 22.1%, &lt;i&gt;p&lt;/i&gt; = 0.015). Total and inpatient health-care costs were higher in these patients. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Endoscopies are underused after ileocecal resection. This contrasts current guidelines. Physicians should be aware of this underuse and perform follow-up examinations more often. </jats:p>
  • Access State: Open Access