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- Title
Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients.
- Authors
Cohen-Mekelburg, Shirley; Gold, Stephanie; Schneider, Yecheskel; Dennis, Madison; Oromendia, Clara; Yeo, Heather; Michelassi, Fabrizio; Scherl, Ellen; Steinlauf, Adam
- Abstract
<bold>Background: </bold>Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence.<bold>Aims: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
UNITED States; CROHN'S disease; INTESTINAL diseases; TREATMENT delay (Medicine); INFLAMMATORY bowel diseases; INSURANCE; BIOTHERAPY; ILEUM surgery; SMALL intestine surgery; THERAPEUTIC use of monoclonal antibodies; DISEASE relapse prevention; HEALTH insurance statistics; CECUM; COLECTOMY; DIGESTIVE organ surgery; LONGITUDINAL method; MEDICAID; MEDICAL care; MEDICARE; MULTIVARIATE analysis; PATIENTS; POSTOPERATIVE care; PREOPERATIVE care; RESEARCH funding; LOGISTIC regression analysis; RETROSPECTIVE studies
- Publication
Digestive Diseases & Sciences, 2019, Vol 64, Issue 1, p196
- ISSN
0163-2116
- Publication type
journal article
- DOI
10.1007/s10620-018-5159-4