Contemporary Risk of Surgery in Patients with Ulcerative Colitis and Crohn's Disease: A Meta-Analysis of Population-based Cohorts.

BACKGROUND We conducted a systematic review with meta-analysis to estimate rates and trends of colectomy in patients with ulcerative colitis (UC), and of primary and re-resection in patients with Crohn's disease (CD), focusing on contemporary risks. METHODS Through a systematic review till September 3, 2019, we identified population-based cohort studies that reported patient-level cumulative risk of surgery in patients with UC and CD. We evaluated overall and contemporary risk (after 2000) of surgery and analyzed time trends through mixed-effects meta-regression. RESULTS In patients with UC (26 studies), overall 1-, 5-, and 10-year risk of colectomy was 4.0% (95% CI,3.3-5.0), 8.8% (7.7-10.0) and 13.3% (11.3-15.5), respectively, with decline in risk over time (p<0.001). Corresponding contemporary risks were 2.8% (2.0-3.9), 7.0% (5.7-8.6) and 9.6% (6.3-14.2), respectively. In patients with CD (22 studies), overall 1-, 5-, and 10-year risk of surgery was 18.7% (15.0-23.0), 28.0% (24.0-32.4) and 39.5% (33.3-46.2), respectively, with decline in risk over time (p<0.001). Corresponding contemporary risks were 12.3% (10.8-14.0), 18.0% (15.4-21.0) and 26.2% (23.4-29.4), respectively. On meta-analysis of 8 studies in patients with CD with prior resection, cumulative risk of second resection 5- and 10-years after first resection was 17.7% (13.5-22.9) and 31.3% (24.1-39.6), respectively. CONCLUSION Patient-level risks of surgery have declined significantly over time, with 5-year cumulative risk of surgery of 7.0% in UC, and 18.0% in CD, in contemporary cohorts. This decline may be related early detection and/or better treatment.