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

Authors:
Stephanie Gold
Stephanie Gold
Hospital for Special Surgery
United States
Yecheskel Schneider
Yecheskel Schneider
Division of Gastroenterology and Hepatology
Madison Dennis
Madison Dennis
101 College Street
Canada
Clara Oromendia
Clara Oromendia
Department of Healthcare Policy and Research
Heather Yeo
Heather Yeo
Yale University School of Medicine
United States
Fabrizio Michelassi
Fabrizio Michelassi
Weill Cornell Medical College
United States
Ellen Scherl
Ellen Scherl
Cornell University
United States

Dig Dis Sci 2018 Jun 7. Epub 2018 Jun 7.

Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA.

Background: Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence.

Aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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June 2018
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