Characteristics Associated With Early Ileocolonic Resection in Pediatric Crohn's Disease.

Abstract

Introduction: Pediatric-onset Crohn's disease (CD) has a more severe phenotype than adult-onset, and nearly one-third of pediatric CD patients will require surgical therapy. There is limited data on patient/disease characteristics that are associated with earlier surgical management.

Methods: All pediatric CD patients (<22 yrs) who underwent ileocolectomy from 2005 to 2021 were included. Unadjusted analyses were performed with Pearson chi-squared tests for categorical dependent variables, and t-tests, or analysis of variance, for numerical dependent variables.

Results: One hundred thirty-five pediatric CD patients underwent ileocolectomy. The median time to surgery was 3.75 yrs. Patients treated with early surgery (<3.75 yrs from diagnosis) were older at diagnosis (16.5 versus 11.6 yrs, P < 0.001) yet had surgery at a younger age (16.8 versus 18.9 yrs, P < 0.001). They also were prescribed fewer CD medications (2.0 versus 4.0, P < 0.001), were less likely to have trialed multiple biologics (25.6% versus 54.2%, P = 0.001), had a shorter time from diagnosis to biologic (0.3 versus 3.5 yrs, P < 0.001), and had a shorter interval from biologic to surgery (0.4 versus 2.5 yrs, P < 0.001). Abscess formation was a more common indication for early surgery (39.4% versus 14.7%, P = 0.002), whereas failure to thrive/refractory pain was more common for later surgery (27.3% versus 55.9%, P = 0.001).

Conclusions: Surgical therapy remains an important component of the overall management of pediatric CD. In our cohort, earlier surgical management was associated with earlier use of biologics, a shorter duration between biologic and surgery, and decreased number of overall medications and biologic agents prior to surgery, suggesting a severe disease phenotype refractory to medical management.