P119 Risk of further surgery and adherence to colonoscopy guidelines following right hemi-colectomy for Crohn’s disease

Introduction The risk of further surgery following right hemicolectomy (RH) for Crohn’s disease (CD) is high (~40%). Recent guidelines advise colonoscopy 6–12 months following RH to reduce the risk of further surgical intervention through medical therapy. We examined the risk of further surgery and use of colonoscopy following index RH. Methods Hospital Episode Statistics were used to identify subjects with CD and RH between 2007 and 2016 in England. Adherence to post resection colonoscopic assessment guidance and risk of further surgery at the same site were investigated. Cox regression models examined the risk factors associated with further surgery and funnel plots demonstrated the colonoscopy practice of providers. Results 12,230 CD subjects (55% female, median age 36 (IQR 26–49) years) had a RH during the study period. 1,367 (11%) had further surgery at the anastomotic site during follow up. 40% of Index surgery and 50% of further surgery was performed during an elective admission. 9% (747/8,293) of those with 5 year at follow up had further surgery as and 17% (366/2,163) of those with 10 years at follow up. Age over 54 compared to 18–24 years had a reduced risk of further surgery (adjusted Hazard ratio 0.81 (95%CI 0.67–0.97), p=0.023) as did less deprived quintiles and those who had index RH on an elective admission (0.69 (0.62–0.77), p 5 was associated with 40% increased further surgery risk (1.41 (1.05–1.89), p=0.023). 51% subjects had a colonoscopy within 2 years of index RH. Recommended 6–12 month colonoscopy assessment increased from 14% in 2007 to 29% in 2016. Overall, unadjusted 6–12 month colonoscopy was 22% however this varied 4-fold between providers. Adjusting for further surgery, illness that might prevent or delay colonoscopy or subject death, 42% of subjects did not undergo a 6–12 month colonoscopy. This fell to 26% if colonoscopy was included. Figure 1 shows a funnel plot of 6–12 month colonoscopy following right hemicolectomy (RH) for Crohn’s disease by provider. Dots represent providers and lines indicate 1, 2 and 3 standard deviations from the mean. Conclusions Despite novel therapeutics and better understanding of the natural history of CD there remains a high risk of recurrent surgery. Colonoscopy assessment after RH has been increasing over time but there remain large unexplained variations in colonoscopy practice between providers.