Abstract Background Ostomies may facilitate healing of perianal fistulising complications (PFC) of Crohn’s disease (CD). The frequency of creating and closing ostomies has not been well characterised in paediatric CD. We described ostomy use in a multicentre cohort. and hypothesized that risk of ostomy differs by PFC timing. PFC before CD diagnosis may be associated with access to care, while later PFC may reflect treatment patterns. Methods We conducted a retrospective review at 7 US paediatric sites. Patients (ages 2-21 yr) with new PFC from CD (1/1/2014–31/12/2019) were included. PFC was defined as perianal abscess and/or fistula. PFC timing was defined as: 1) Before/At CD if identified before or 30 days after CD diagnosis, or 2) After CD if ≥ 30 days after CD diagnosis. Analyses included Student t-test, Kruskal-Wallis, and logistic regression. Results Of 291 patients with PFCs, 186 (64%) developed PFC Before/At CD, and 95 (33%) After CD. Overall, 36 (12.4%) underwent ostomy, more commonly if PFC developed After CD (23/95, 24.2%) than if developed Before/At CD (11/186, 5.9%; p 0.001) (10 dates were missing). In adjusted analysis (Table 1), ostomy was 3x more common among female patients. Patients with PFC After CD who did not have commercial insurance had the highest odds of ostomy, 5x more than those with PFC Before/At CD with commercial insurance (Figure 1). Of the 36 patients who underwent ostomy creation, 28 (78%) had their ostomy closed after median 371 days (interquartile range IQR 199-799), among whom 3 (10%) had a 2nd ostomy. In total 11 (including all 3 with 2ndostomy) had an ostomy through the end of the 3-yr study period (31% of all with ostomy, 3.8% of all with PFC) with a median 1043 days from ostomy creation to study end (IQR 812-1204). It is not clear how many, if any, had ostomy closure after study end. Among the 25 who had successful ostomy closure, the median days to closure was 350 (IQR 201-665). There was no difference in ostomy closure by race (p = 0.53) or timing of PFC (p = 0.11). However, commercial insurance was associated with shorter median time to ostomy closure 342 days (IQR 77-513) compared to those without commercial insurance 530 days (IQR 24-916) for a median difference of 6.3 months (p = 0.045). Conclusion Among children with CD and PFC in a multicentre retrospective cohort, 12% had an ostomy created, among whom nearly 30% ultimately required years-long ostomy. Lack of commercial insurance and developing PFC after diagnosis were associated with 5-fold increased odds of ostomy, likely reflecting barriers to care. Strategies to prevent PFC and reduce the need for ostomy, through earlier access, and optimised medical therapy are needed. Conflict of interest: Gadepalli, Samir: none Manning, Lauren: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research McMahon, Lisa: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Mollen, Kevin: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Nwomeh, Benedict: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Phillips, Michael: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Gayer, Christopher: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Chavannes, Mallory: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research. I have a CDA from the Robert A Winn Foundations, which funding partially comes from a collaboration between the VCU Foundation and the BMS Foundation. I receive consultation fees from CapsoVision Inc. Egberg, Matthew: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Kandavel, Prashanthi: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Maltz, Ross: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Minar, Phillip: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Pasternak, Brad: Grant funding to my institution from the Agency for Healthcare Research and Quality to fund this current research Kimberly, Armanda: No conflict of interest McDonnell, Erin: No conflict of interest Anita, Sejdiu: No conflict of interest Valenzuela, Isabella: No conflict of interest Tribble, Alison: Grant funding to my institution from the Agency for Healthcare Research and Quality (AHRQ) to fund this current research. Grant from the Cystic Fibrosis Foundation. Grant support from another AHRQ grant. Prof. Dr. Adler, Jeremy: I have received funding from Janssen Research & Development LLC for studies of the SEMA-CD colonoscopy score.
Gadepalli et al. (Thu,) studied this question.