Evolution of Surgery Risk in Crohn's Disease

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atmire.migration.oldid4216
dc.contributor.advisorKaplan, Gilaad
dc.contributor.authorFrolkis, Alexandra
dc.contributor.committeememberJette, Nathalie
dc.contributor.committeememberdeBruyn, Jennifer
dc.date.accessioned2016-10-04T17:26:50Z
dc.date.available2016-10-04T17:26:50Z
dc.date.issued2016
dc.date.submitted2016en
dc.description.abstractWhile many individuals with Crohn’s disease require surgery for management, the risks of surgery are not well characterized in population-based studies. Advances in medical management may have influenced the risk of surgery over time. However, studies have not adequately evaluated the effect of smoking on temporal trends in surgery risk for Crohn’s disease. A mixed methodology approach was used to: 1) describe the morbidity and mortality associated with surgery in Crohn’s disease; 2) summarize the risk of first and second surgery in Crohn’s disease; 3) evaluate whether the risk of surgery has changed over time; and 4) assess whether smoking has influenced the risk of surgery in Crohn’s disease. In Alberta, postoperative morbidity (25%) and mortality (1.2%) was high for Crohn’s disease. A systematic review and meta-analysis found that the estimated pooled risk of surgery 10 years after the diagnosis of Crohn’s disease was 46.6% (95% Confidence Interval [CI] 37.7%-57.7%); however, the risk of first surgery in Crohn’s disease was significantly decreasing over time (meta-regression p- value<0.01). Another systematic review and meta-analysis identified that 10 years following the first surgery the estimated pooled risk of a second surgery was 35% (95% CI 31.8%-38.6%) and this risk was also decreasing over time (Cochran Q for subgroup comparison p-value<0.01). Finally, a nationally representative cohort showed that from 1996 to 2009 the risk of first surgery decreased significantly and the proportion of incident Crohn’s disease patients who have never smoked significantly increased annually by an estimated 3% (Risk Ratio [RR] 1.03; 95% CI 1.02-1.04). Furthermore, in older adults (>40 years at diagnosis) smoking was associated with twice the risk of surgery compared to those who did not smoke. The results of this dissertation demonstrate that surgery is associated with significant morbidity and mortality. Reassuringly, the risk of surgery is decreasing over time. In part, this decrease may be explained by fewer Crohn’s disease patients who are smokers at diagnosis. Thus, public health initiatives that reduce the prevalence of smoking in the general population may reduce the burden of Crohn’s disease.en_US
dc.identifier.citationFrolkis, A. (2016). Evolution of Surgery Risk in Crohn's Disease (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26008en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/26008
dc.identifier.urihttp://hdl.handle.net/11023/3386
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectMedicine and Surgery
dc.subjectPublic Health
dc.subject.classificationCrohn's diseaseen_US
dc.subject.classificationEpidemiologyen_US
dc.subject.classificationSurgeryen_US
dc.titleEvolution of Surgery Risk in Crohn's Disease
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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