Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients

摘要

BackgroundStudies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence.AimsWe 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.MethodsWe 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.ResultsA 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 8weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p0.001) 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.ConclusionsThere 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.