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Surgical rates for Crohn’s Disease are decreasing: a population-based time trend analysis and validation study

Ma, Christopher; Moran, Gordon W.; Benchimol, Eric I.; Targownik, Laura E.; Heitman, Steven J.; Hubbard, James N.; Seow, Cynthia H.; Novak, Kerri L.; Ghosh, Subrata; Panaccione, Remo; Kaplan, Gilaad G.


Christopher Ma

Clinical Associate Professor

Eric I. Benchimol

Laura E. Targownik

Steven J. Heitman

James N. Hubbard

Cynthia H. Seow

Kerri L. Novak

Subrata Ghosh

Remo Panaccione

Gilaad G. Kaplan


Temporal changes for intestinal resections for Crohn’s disease (CD) are controversial. We validated administrative database codes for CD diagnosis and surgery in hospitalized patients and then evaluated temporal trends in CD surgical resection rates.
First, we validated International Classification of Disease (ICD)-10-CM coding for CD diagnosis in hospitalized patients and Canadian Classification of Health Intervention coding for surgical resections. Second, we used these validated codes to conduct population-based surveillance between fiscal years 2002 and 2010 to identify adult CD patients undergoing intestinal resection (n=981). Annual surgical rate was calculated by dividing incident surgeries by estimated CD prevalence. Time trend analysis was performed and annual percent change (APC) with 95% confidence intervals (CI) in surgical resection rates were calculated using a generalized linear model assuming a Poisson distribution.
In the validation cohort, 101/104 (97.1%) patients undergoing surgery and 191/200 (95.5%) patients admitted without surgery were confirmed to have CD on chart review. Among the 116 administrative database codes for surgical resection, 97.4% were confirmed intestinal resections on chart review. From 2002 to 2010, the overall CD surgical resection rate was 3.8 resections per 100 person-years. During the study period, rate of surgery decreased by 3.5% per year (95% CI: -1.1%, -5.8%), driven by decreasing emergent operations (-10.1% per year [95% CI: -13.4%, -6.7%]) whereas elective surgeries increased by 3.7% per year (95% CI: 0.1%, 7.3%).
Overall surgical resection rates in CD are decreasing, but a paradigm shift has occurred whereby elective operations are now more commonly performed than emergent surgeries.


Ma, C., Moran, G. W., Benchimol, E. I., Targownik, L. E., Heitman, S. J., Hubbard, J. N., …Kaplan, G. G. (2017). Surgical rates for Crohn’s Disease are decreasing: a population-based time trend analysis and validation study. American Journal of Gastroenterology, 112,

Journal Article Type Article
Acceptance Date Aug 10, 2017
Online Publication Date Oct 31, 2017
Publication Date Dec 1, 2017
Deposit Date Nov 1, 2017
Publicly Available Date Nov 1, 2017
Journal American Journal of Gastroenterology
Print ISSN 0002-9270
Electronic ISSN 1572-0241
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 112
Keywords Crohn’s disease; surgery; ICD-10-CM; validation
Public URL
Publisher URL


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