Decreasing Primary Resection Rates for Crohn’s Disease but Unchanged Re-Resection Rates: A Nationwide Danish Population-Based Cohort Study From 1997 to 2021

BACKGROUND & AIMS: The overarching goal in the medical management of Crohn's disease (CD) is to minimize disease burden for patients and prevent disease progression, where surgery often is necessary. The aim of this study was to examine rates of intestinal resections in CD over the past decades in a nationwide cohort. METHODS: We identified all patients diagnosed with incident CD in Denmark from 1997 to 2021 from the Danish National Patient Registry. Cumulative incidences of intestinal resections and measures of disease severity were compared between calendar periods. RESULTS: Among 18,303 patients with CD, 5-year resection rates decreased from 28% (95% confidence interval [CI], 26%-31%) in 1997 to 2000 to 16% (95% CI, 15%-17%) in 2013 to 2017. The proportion of elective surgeries increased from 60.2% to 67.7%, patients were operated earlier in their disease course (preoperative disease duration decreased from 1.9 years to 0.2 years), and more patients underwent laparoscopic procedures (increasing from 7.3% to 64.1%). There was no evidence of increased disease severity or complexity at first intestinal resection over time. From 1997 to 2017, 5-year rates of re-resections remained constant at 16-17%. Use of postoperative biologics within 12 months after first resection gradually increased to 30%, whereas the use of endoscopy within 12 months increased to 39% in the most recent period. CONCLUSIONS: Rates of primary resections in CD have decreased over the past decades without any evidence that this has been achieved at the expense of increased complexity at surgery. Re-resection rates have not changed in the past decades, suggesting a potential for improvement.