Declining Bowel Surgery Rates and Predictors for Surgery of Crohn's Disease: A Prospective Inception Cohort in Eastern China.

Objective: To investigate the rate of Crohn's disease (CD)-related bowel surgery within an inception cohort in Eastern China in the era of evolving diagnostic and therapeutic expertise.

Methods: A single-center, prospective cohort study was conducted from July 2019 to June 2022 in China. Patients with newly diagnosed CD were followed annually. Risk factors of bowel surgery for complications such as obstruction, fistula, perforation, and bleeding were evaluated.

Results: The cohort consisted of 438 patients with newly diagnosed CD, with a male predominance (73.5%) and a median age of 28 years. Of these, 68 patients underwent bowel surgery, with the 1-, 2-, and 3-year cumulative surgery rates being 11.8%, 14.3%, and 15.4%. Multivariate analysis identified patient enrollment in the third year (adjusted hazard ratio [aHR] 0.45, 95% confidence interval [CI] 0.21-0.99), smoking (aHR 3.57, 95% CI 1.70-7.47), stricturing (aHR 31.38, 95% CI 10.93-90.07) or penetrating behavior (aHR 39.83, 95% CI 13.16-120.58), and hypoalbuminemia (aHR 1.95, 95% CI 1.12-3.38) as independent predictors. Patients enrolled in 2019-2020, 2020-2021, and 2021-2022 had 1-year surgery rates of 18.4%, 14.2%, and 5.3%, respectively. Significant differences were observed among the three cohorts in age at diagnosis, onset symptoms, disease location, and behavior.

Conclusions: Disease behavior, year of enrollment, smoking, and hypoalbuminemia were independent factors related to bowel surgery in CD. First-year bowel surgery rate and age at diagnosis decreased over the 3 years, while the proportions of patients with onset perianal symptoms, inflammatory behavior, and perianal disease increased.