Scientific paper
Crohn's disease patients who quit smoking have a reduced risk of reoperation for recurrence

https://doi.org/10.1016/j.amjsurg.2003.11.007Get rights and content

Abstract

Background

Smoking increases the risk of recurrent Crohn's disease (CD).

Methods

We examined the impact of smoking, quitting smoking, and other factors on reoperation for recurrent CD. We distributed questionnaires to 584 patients from a surgical database whom had undergone a surgical operation for ileocecal CD to assess history of smoking, medical, behavioral, and demographic information.

Results

Two hundred sixty-seven patients completed the questionnaire (46% response). Smokers were more likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (relative incidence rates [RIR] 1.32, 95% confidence interval [CI]: 1.10 to 1.60; RIR 1.55, 95% CI: 1.09 to 2.20; and RIR 1.77, 95% CI: 1.02 to 3.06, respectively) and were more likely to have undergone one reoperation for recurrent ileocecal CD (RIR 1.48, 95% CI: 1.18 to 1.86). Patients who quit smoking were less likely to have undergone 1, 2, and 3 reoperations for recurrence at any site (RIR 0.25, 95% CI: 0.15 to 0.41; RIR 0.30, 95% CI: 0.16 to 0.57; and RIR 0.25, 95% CI: 0.10 to 0.71, respectively) and were less likely to have undergone one reoperation for recurrent ileocecal CD (RIR 0.27, 95% CI: 0.15 to 0.47).

Conclusions

This study indicates that patients with ileocecal CD who stop smoking reduce the risk of reoperation for recurrent CD.

Section snippets

Sample

Our target population consisted of all living CD patients in our computer database whom had undergone an operation (resection [94%], strictureplasty, or bypass) for ileocecal CD and had been followed up for at least 2 years. Medical records and mailing address were available for the 584 CD patients who met the inclusion criteria. We distributed questionnaires and, when possible, interviewed these patients over 3 months. The study was approved by both the Institutional Review Board Human

Results

Two hundred and sixty-seven of 584 patients completed the questionnaire (response rate of 46%). The mean follow-up for the 267 respondents was 18.73 years (range 2 to 59).

Smoking had a statistically significant impact on reoperation rates (Table 1, Table 2). Smokers had an increased risk of one, two and three reoperations for recurrence at any site (Table 1 and Fig. 1) and an increased risk of one reoperation for recurrent ileocecal CD (Table 2 and Fig. 2). The separate analysis including

Comments

These data demonstrate a significant impact of active smoking on reoperation rates for CD. Patients who actively smoke are not only more likely to have a reoperation for recurrent disease but they are more likely to have multiple and additional operations [13], [14]. We did not establish a dose-response relationship. Moreover, there is no apparent impact of smoking on Crohn's disease after subtotal colectomy and ileostomy [15]. Nevertheless, smoking is an important predictive factor for

Acknowledgements

Data collection was done at the University Hospital Birmingham NHS Trust, Birmingham, England. William Ryan performed the data analysis and manuscript composition at Stanford University School of Medicine, Stanford, California, under the supervision of Drs. Allan and Keighley. Catherine Ley, PhD, of the Department of Health Research and Policy at Stanford University, supervised the statistical analysis. A grant from the Stanford University Medical Student Travel Scholars Program helped to fund

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