Early Adjuvant Biologic Therapy to Prevent Repeated Intestinal Resection in Children with Crohn's Disease

Introduction: Children with Crohn Disease may require repeated intestinal resections to treat disease complications. We aimed to investigate whether biologic immunomodulatory treatment immediately after initial surgical intervention reduced subsequent need for surgery.

Methods: We reviewed the Pediatric Health Information System (PHIS), a multi-center longitudinal health database of 48 children’s hospitals in the United States. We queried PHIS for all children <18 years with a diagnosis of Crohn Disease who underwent one or more intestinal resections between 2017-2024 by evaluating appropriate ICD-10 procedure codes. Additional data on patient demographics, pharmacologic treatment and readmissions were abstracted. The time between surgical procedures was recorded. Kaplan-Meier analysis was performed to evaluate the time to subsequent intestinal resection in patients who received postoperative biologic therapy within the same hospital admission as their first procedure, compared with those who did not.

Results: A total of 1,086 patients undergoing 1,256 procedures met inclusion criteria, with a median age of 16.1 (IQR 13.6 – 17.9) years and a slight male preponderance (54.8%). Overall, 184 (16.9%) patients received early biologic therapy and 127 (11.7%) underwent a second intestinal resection within 5 years of their index operation. Kaplan-Meier analysis revealed that there was no difference in 5-year progression to repeated surgery in children who received early postoperative biologic therapy versus those who did not (log-rank test, p = 0.52) [Figure].

Conclusion: Early postoperative biologic therapy does not appear to reduce progression to recurrent intestinal resection within 5 years of the index procedure.