Factors That Determine Risk for Surgery in Pediatric Patients With Crohn's Disease  Marc E. Schaefer, Jason T. Machan, David Kawatu, Christine R. Langton, James Markowitz, Wallace Crandall, David R. Mack, Jonathan S. Evans, Marian D. Pfefferkorn, Anne M. Griffiths, Anthony R. Otley, Athos Bousvaros, Subra Kugathasan, Joel R. Rosh, David J. Keljo, Ryan S. Carvalho, Gitit Tomer, Petar Mamula, Marsha H. Kay, Benny Kerzner, Maria Oliva–Hemker, Michael D. Kappelman, Shehzad A. Saeed, Jeffrey S. Hyams, Neal S. LeLeiko  Clinical Gastroenterology and Hepatology  Volume 8, Issue 9, Pages 789-794.e2 (September 2010) DOI: 10.1016/j.cgh.2010.05.021 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 Cumulative incidence of surgery. Cumulative incidence of all first CD-related surgery, first bowel surgery, and first non-bowel surgery at 5 years after diagnosis was estimated to be 17.7% (95% CI,13.5%–22.9%), 13.8% (95% CI,10.1%–18.8%), and 4.5% (95% CI, 2.6%–7.7%), respectively. Number of patients (n) followed for 1, 2, 3, 4, and 5 years after diagnosis is listed below the X-axis. Clinical Gastroenterology and Hepatology 2010 8, 789-794.e2DOI: (10.1016/j.cgh.2010.05.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 Cumulative incidence of surgery by location. Kaplan–Meier method found a statistically significant difference for risk of bowel surgery (P = .026) among the 4 different disease location phenotypes. Presence of distal disease was associated with a decreased risk for bowel surgery (P < .004). *Proximal, esophagus to jejunum; **distal, transverse colon to rectum. Clinical Gastroenterology and Hepatology 2010 8, 789-794.e2DOI: (10.1016/j.cgh.2010.05.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 Disease severity and behavior before bowel surgery. (A) Disease severity for 57 patients who had a first bowel surgery. An increase in disease severity by 1 level of the PGA, on average, was associated with a 3-fold increased risk of bowel surgery within the next 3 months (hazard ratio, 3.3; 95% CI, 2.6–4.4; P < .0001). (B) Disease behavior for 51 patients who had a Vienna classification before first bowel surgery. Stricturing disease was associated with a 12.4-fold increased risk of bowel surgery within the next 3 months (hazard ratio, 12.4; 95% CI, 6.6–23.5; P < .0001), and penetrating disease was associated with a 4.5-fold increased risk of bowel surgery within the next 3 months (hazard ratio, 4.5; 95% CI, 2.2–9.3; P < .0001). Clinical Gastroenterology and Hepatology 2010 8, 789-794.e2DOI: (10.1016/j.cgh.2010.05.021) Copyright © 2010 AGA Institute Terms and Conditions

Supplementary Figure 1 Distal disease by age. Ninety-eight percent (95% CI, 87.7%–99.6%) of the 0- to 5-year-old group had disease between the transverse colon and rectum (distal disease) compared with 79% (95% CI, 75.1%–82.4%) of the 6- to 12-year-old age group and 76% (95% CI, 71.6%–80.7%) of the 13- to 16-year-old age group. Chi-square analysis found a statistically significant difference for the presence of disease between the transverse colon and rectum among these 3 age groups (P = .007). Clinical Gastroenterology and Hepatology 2010 8, 789-794.e2DOI: (10.1016/j.cgh.2010.05.021) Copyright © 2010 AGA Institute Terms and Conditions