Significant reduction of emergency stoma surgeries for CD

Discrepancies in surgical rates for CD are observed between population-based studies and referral cohorts. As medical therapy advances further, temporal trends in rates of surgical ostomy creation need to be re-evaluated.

Ma et al. conducted a population-based surveillance using the Discharge Abstract Database of the Calgary Health Zone [13]. Data for the period between April 1, 2002 and March 31, 2009 were included. Patients aged ≥18 years were identified who were admitted for CD and underwent surgical stoma creation (n=427).

The overall stoma creation rate was 1.9 stomas per 100 person-years (95% CI: 1.5-2.5). The rate of stoma creation between 2002 and 2009 trended downwards by an average of 5.8% per year (95% CI: −11.4%, 0.2%). It decreased from 2.3 stomas per 100 person-years (95% CI: 1.8-3.0) in 2002 to 1.6 stomas per 100 person-years (95% CI: 1.3-2.1) in 2009. When stratified by surgical indication, the rate of emergency-ostomy creation decreased significantly from 2002 to 2009, with an annual change of −14.6% (95% CI: −22.8-−5.6%). In contrast, elective-ostomy creation rate remained stable with an annual change of 3.1% (95% CI: −2.8-9.4%).

At the beginning of the study period, emergency-stoma creation rate exceeded elective-stoma creation rate (1.3 emergency stomas vs. 1.0 elective stomas per 100 person-years). By the end of the study period, this pattern had reversed (0.6 emergency stomas vs. 1.1 elective stomas per 100 person-years).

The frequency of emergency compared with elective stoma surgery was observed to shift between 2005 and 2006. Thus, this large population-based study showed a significant reduction in the rate of emergency-stoma surgeries for CD. A paradigm shift in surgical care trended towards increasing the rate of elective-stoma creation during the biologic era.