Trends in Surgical Recurrence among Pediatric Crohn's Disease Patients Using Administrative Claims Data.

Background Despite the growing armamentarium of medical therapies for Crohn's disease (CD), well over half of patients with CD will require surgical intervention. We estimated the surgical recurrence risk and characterized postoperative treatment and colonoscopy use in pediatric CD patients using a large, geographically diverse administrative claims database. Methods We analyzed postresection pediatric (<= 18 years) CD patients identified in the 2007-2018 IQVIA Legacy PharMetrics administrative claims database using diagnosis and procedural codes. We estimated the surgical recurrence risk over time, characterized postoperative treatments, and reported the frequency of colonoscopy 6-15 months postoperatively. Results Among 434 pediatric CD patients who underwent intestinal resection (median age 16 years, 46% female), risk of surgical recurrence was 3.5%, 4.6%, and 5.3% at 1, 3, and 5 years, respectively. Patients were most commonly prescribed an immune modulator (33%), anti-tumor necrosis factor agent (32%), or antibiotic (27%) postoperatively. Among 281 patients with >= 15 months of follow-up, 24% underwent colonoscopy 6-15 months postoperatively. Conclusions Surgical recurrence risk increases over time and the low colonoscopy rates and treatment variation postoperatively represent an opportunity for practice improvement. Lay Summary The risk of surgical recurrence among children with Crohn's disease increases over time with over 5% undergoing repeat intestinal surgery within 5 years of initial surgery. Postoperative treatment and colonoscopy surveillance practices are crucial guidance for effective postsurgical disease prevention strategies.