(C-019) Rate of Bowel Resection Surgeries among Children with Inflammatory Bowel Disease

Background: Children with Inflammatory Bowel Disease (IBD), including Ulcerative Colitis (UC) and Crohn’s Disease (CD), undergo surgery for severe or treatment-resistant disease. The treatment landscape for pediatric IBD has evolved substantially over the last two decades; yet current data on the prevalence of surgery in this population are lacking.

Objectives: We sought to describe the frequency and characteristics of bowel surgery in an incident cohort of pediatric IBD.

Methods: We conducted a retrospective cohort study using the Healthcare Integrated Research Database (HIRD) containing claims for a commercially-insured population. We identified incident cases of pediatric IBD between 1/1/2010 and 12/31/2023 using a validated algorithm requiring ≥1y IBD-free enrollment before the first diagnosis. Surgeries were identified by procedure codes. IBD type was assigned using initial diagnoses. Patients were followed until surgery, death, health plan disenrollment, attaining 22 years of age, or study end date (8/31/2024).

Results: We identified 5,250 children with incident IBD, 59% CD and 41% UC, with a slight male predominance. The mean diagnosis age was 14.8(CD) and 15.8(UC) years. Region, area-level SES, and race/ethnicity were similar across groups.

For patients with CD, 9% had surgery by 1y (3% on index), 13% by 3y and 16% by 5y. Median LOS was 9d and 10% were readmitted within 30d of discharge. Time to initial surgery was longer for those diagnosed when < 10y vs ≥10y (HR=0.20, 95% CI: 0.11-0.36). After surgery, 80% of patients received ≥1 IBD medication. Of those with an initial surgery, 17% had a subsequent bowel surgery over a median of 2.9y of follow up. The median time from initial to second surgery was 290d (95% CI: 203-537).

For patients with UC, 6% had surgery by 1y (0.7% on index), 11% by 3y and 12% by 5y. Median LOS was 15d and 19% were readmitted within 30d. Time to surgery was possibly shorter for those diagnosed when < 5y vs ≥5y (HR=1.76, 95% CI: 0.86-3.58). After surgery, 43% patients received ≥1 IBD medication.

Conclusions: Despite the many advances in medical therapy over the last few decades, surgery plays a significant role in the care of children with IBD. Identifying optimal pharmacologic strategies, focusing on pre- and post-operative medical therapy, are critical for patient and family counseling and improving outcomes for these conditions.