P0792 - Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Rania Daaboul, MS⁴, Azizullah Beran, MD⁵, Babu Mohan, MD, MS⁶, Emad Mansoor, MD⁷, Jeffry Katz, MD⁸, Gregory Cooper, MD⁸, Vu Nguyen, MD^8
1Case Western Reserve University School of Medicine, Cleveland, OH; ²Methodist Dallas Medical Center, Dallas, TX; ³Cleveland Clinic Akron General, Akron, OH; ⁴Oakland University William Beaumont School of Medicine, Farmington Hills, MI; ⁵Indiana University, Indianapolis, IN; ⁶University of Utah Health School of Medicine, Salt Lake City, UT; ⁷Case Western Reserve University / University Hospitals, Cleveland, OH; ⁸Case Western Reserve/UHCMC, Cleveland, OH

Introduction: Inflammatory bowel diseases (IBDs) are chronic diseases that often require surgery. However, there is considerable debate in the literature as to whether the risk of surgery has decreased over time. We performed a systematic review and meta-analysis to establish the cumulative risk of surgery among patients with IBD and evaluated how this risk has changed over time.



Methods: We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception through June 2023. Meta-analysis was performed by standard methodology using the random-effects model and heterogeneity was assessed using the I2% statistics. The analysis included population-based studies published as articles and abstracts that reported risks of surgery at 1, 5, or 10 years after a diagnosis of Crohn’s disease (CD) and/or ulcerative colitis (UC). Subgroup analysis based on the decade of diagnosis for studies conducted in 1955-1969,1970-1979, 1980-1989, 1990-1999, 2000-2009 and after 2010 was performed.

Results: Our final analysis included 62 studies (105 study arms) that included 221,574 patients with an age range of 11.2 - 46 years, and 50.4% were female. 35.8% Crohn's disease (CD) and 64% ulcerative colitis (UC). Based on all population-based studies the risk of surgery by 1, 5, and 10 years after diagnosis of IBD was 7.6% (95% confidence interval [CI], 6.2-9.2%), 17.8% (95% CI, 15.3-20.5%), and 24.5% (95% CI, 21.2-28.3%), respectively. The risk of surgery by 1, 5, and 10 years after diagnosis of CD was 12.7% (95% CI, 9.8-16.2%), 28.1% (95% CI, 24.1-32.6%), and 39.3% (95% CI, 31.9-47.2%), respectively. The risk of surgery by 1, 5, and 10 years after diagnosis of UC was 4.5% (95% CI, 3.1-6.6%), 9.7% (95% CI, 7.3-12.9%), and 13.4% (95% CI, 10.7-16.7%), respectively. The cumulative risk of surgery steadily declining over time by the decade of diagnosis for studies conducted 1955-1969,1970-1979, 1980-1989, 1990-1999, 2000-2009 and after 2010 (Table 1).

Discussion: Based on our systematic review and meta-analysis of population-based studies, the risk of intestinal surgery among patients with IBD has been declining over the past 7 decades. Further studies are needed to identify factors that contribute to the declining surgical risk in IBD.



Disclosures:


Rami Musallam, MD¹, Syed Hamaad Rahman, DO², Faris Shweikeh, MD³, Rania Daaboul, MS⁴, Azizullah Beran, MD⁵, Babu Mohan, MD, MS⁶, Emad Mansoor, MD⁷, Jeffry Katz, MD⁸, Gregory Cooper, MD⁸, Vu Nguyen, MD⁸. P0792 - Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.