학술논문
Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients
Original Article
Original Article
Document Type
Academic Journal
Author
Source
Digestive Diseases and Sciences. January 2019, Vol. 64 Issue 1, p196, 8 p.
Subject
Language
English
ISSN
0163-2116
Abstract
Author(s): Shirley Cohen-Mekelburg [sup.1], Stephanie Gold [sup.2], Yecheskel Schneider [sup.1], Madison Dennis [sup.2], Clara Oromendia [sup.3], Heather Yeo [sup.4], Fabrizio Michelassi [sup.4], Ellen Scherl [sup.1], Adam Steinlauf [sup.1] Author Affiliations: [...]
Background Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence. Aims We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. Methods We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively. Results A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy. Conclusions There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.
Background Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence. Aims We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. Methods We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively. Results A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy. Conclusions There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.