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- Soop, Mattias, et al.
(författare)
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Hospital surgical volumes and outcomes in ileocaecal resection for Crohn's disease in Sweden 2000-2019 : A national cohort study
- 2024
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 18, s. I2048-I2049
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Intestinal resection for CD is often complex and remains associated with significant postoperative morbidity. In several other types of complex surgery, increased case volume has been associated with better outcomes. In surgery for CD, such an association has been difficult to assess.Method: In this nationwide cohort study, we used the National Patient Register to identify all CD patients who underwent their first (primary) ileocecal resection in Sweden 2000-2019 at age 15 years or above. Hospitals were grouped into low, middle, and high-volume centres (1-24, 25-36 and ≥37 resections per year).Result: In the 20-year study period, 3396 patients underwent primary ileocecal resection for CD in Sweden; 2371 (69.8%), 527 (15.5%), and 498 (14.7%) in low-, middle-, and high-volume hospitals, respectively. Laparoscopic surgery was performed in 351 (15%), 126 (24%), and 122 (24%) patients in low-, middle-, and high-volume centers. Surgical reintervention within 100 days was performed in 117 (4.9%), 19 (3.6%) and 13 (2.6%) patients in the three groups (adjusted odds ratios 0.72 (95% confidence interval 0.43-1.15) for middle-volume and 0.52 (0.28-0.89) for high-volume hospitals, compared to low-volume hospitals, Figure 1). There were no differences in the length of index admission hospitalstay or mortality.Discussion: In primary ileocecal resection for Crohn’s disease (CD), high-volume hospitals had lower odds of early surgical reintervention ,compared to low-volume hospitals. Hospital groups did not differ in mortality or length of stay. This finding may inform discussions of subspecialization and centralization in surgery for Crohn’s disease.
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| 2. |
- Olén, Ola, et al.
(författare)
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Increasing Risk of Lymphoma Over Time in Crohn's Disease but Not in Ulcerative Colitis : A Scandinavian Cohort Study
- 2023
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier. - 1542-3565 .- 1542-7714. ; 21:12, s. 3132-3142
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Earlier studies have provided varying risk estimates for lymphoma in patients with inflammatory bowel disease (IBD), but often have been limited by detection biases (especially during the first year of follow-up evaluation), misclassification, and small sample size; and rarely reflect modern-day management of IBD.Methods: We performed a binational register-based cohort study (Sweden and Denmark) from 1969 to 2019. We compared 164,716 patients with IBD with 1,639,027 matched general population reference individuals. Cox regression estimated hazard ratios (HRs) for incident lymphoma by lymphoma subtype, excluding the first year of follow-up evaluation.Results: From 1969 to 2019, 258 patients with Crohn's disease (CD), 479 patients with ulcerative colitis (UC), and 6675 matched reference individuals developed lymphoma. This corresponded to incidence rates of 35 (CD) and 34 (UC) per 100,000 person-years in IBD patients, compared with 28 and 33 per 100,000 person-years in their matched reference individuals. Although both CD (HR, 1.32; 95% CI, 1.16–1.50) and UC (HR, 1.09; 95% CI, 1.00–1.20) were associated with an increase in lymphoma, the 10-year cumulative incidence difference was low even in CD patients (0.08%; 95% CI, 0.02–0.13). HRs have increased in the past 2 decades, corresponding to increasing use of immunomodulators and biologics during the same time period. HRs were increased for aggressive B-cell non-Hodgkin lymphoma in CD and UC patients, and for T-cell non-Hodgkin lymphoma in CD patients. Although the highest HRs were observed in patients exposed to combination therapy (immunomodulators and biologics) or second-line biologics, we also found increased HRs in patients naïve to such drugs.Conclusions: During the past 20 years, the risk of lymphomas have increased in CD, but not in UC, and were driven mainly by T-cell lymphomas and aggressive B-cell lymphomas.
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