Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1182-1188
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1182
Optimizing perioperative Crohn's disease management: Role of coordinated medical and surgical care
Jennifer L Bennett, Christina Y Ha, Jonathan E Efron, Susan L Gearhart, Mark G Lazarev, Elizabeth C Wick
Jennifer L Bennett, Jonathan E Efron, Susan L Gearhart, Elizabeth C Wick, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Christina Y Ha, Mark G Lazarev, Division of Gastroenterology, the Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Christina Y Ha, Division of Digestive Diseases, the David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, United States
Author contributions: Bennett JL, Ha CY and Wick EC contributed to study conception and design, data accrual and interpretation and manuscript writing; Efron JE, Gearhart SL and Lazarev MG contributed to manuscript and revision; all authors have approved the final draft for submission.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elizabeth C Wick, MD, Assistant Professor of Surgery, The Johns Hopkins University School of Medicine, Blalock Room 658, 600 N Wolfe St, Baltimore, MD 21287, United States. ewick1@jhmi.edu
Telephone: +1-410-9557323 Fax: +1-410-6149886
Received: June 8, 2014
Peer-review started: June 8, 2014
First decision: July 9, 2014
Revised: July 24, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 28, 2015
Processing time: 233 Days and 5.1 Hours
Abstract

AIM: To investigate rates of re-establishing gastroenterology care, colonoscopy, and/or initiating medical therapy after Crohn’s disease (CD) surgery at a tertiary care referral center.

METHODS: CD patients having small bowel or ileocolonic resections with a primary anastomosis between 2009-2012 were identified from a tertiary academic referral center. CD-specific features, medications, and surgical outcomes were abstracted from the medical record. The primary outcome measure was compliance rates with medical follow-up within 4 wk of hospital discharge and surveillance colonoscopy within 12 mo of surgery.

RESULTS: Eighty-eight patients met study inclusion criteria with 92% (n = 81) of patients returning for surgical follow-up compared to only 41% (n = 36) of patients with documented gastroenterology follow-up within four-weeks of hospital discharge, P < 0.05. Factors associated with more timely postoperative medical follow-up included younger age, longer length of hospitalization, postoperative biologic use and academic center patients. In the study cohort, 75.0% of patients resumed medical therapy within 12 mo, whereas only 53.4% of patients underwent a colonoscopy within 12 mo of surgery.

CONCLUSION: Our study highlights the need for coordinated CD multidisciplinary clinics and structured handoffs among providers to improve of quality of care in the postoperative setting.

Keywords: Coordinated care; Crohn’s disease; Post-operative prophylaxis; Multidisciplinary clinics; Surgery

Core tip: Adherence to evidence based management of patients with Crohn’s disease requires care coordination and communication between surgeons and gastroenterologists. Surgeons need to facilitate return visits after surgery to the gastroenterologists.