{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T08:16:19Z","timestamp":1788509779625,"version":"build-2803163510"},"reference-count":36,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,29]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Despite numerous studies on surgical outcomes in Crohn\u2019s disease (CD), global evidence remains fragmented, with limited synthesis of data on international surgical trends, regional variations and comparative outcomes. This systematic review aims to evaluate the rates of CD-related surgeries in the biologic era and to identify evidence gaps to inform future surgical strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A comprehensive search will be conducted in MEDLINE, Embase, and CINAHL from 9 February 2015 to 10 February 2025. A combination of controlled vocabulary and free-text terms related to surgical interventions and CD will be used to identify relevant literature. Studies eligible for inclusion include observational studies and randomised controlled trials (RCTs). The primary outcome is overall surgical rates in CD. Secondary outcomes include emergency versus elective surgery, minimally invasive vs conventional approaches, disease duration prior to surgery, permanent stoma formation rates, reconstruction approach and postoperative complications. Both adult and paediatric populations are considered. The risk of bias will be assessed independently by reviewers using appropriate tools. Meta-analyses or narrative synthesis will be conducted based on study heterogeneity, with subgroup and sensitivity analyses to explore regional, temporal and methodological variability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol does not require ethical approval, as it involves secondary data analysis. Findings will be disseminated via peer-reviewed journal publications and relevant conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration<\/jats:title>\n                    <jats:p>CRD420251006137<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109537","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:25:18Z","timestamp":1786969518000},"page":"e109537","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Global surgical landscape and outcomes in Crohn\u2019s disease in the biologics era: a systematic review protocol"],"prefix":"10.1136","volume":"16","author":[{"given":"Chhagan Lal","family":"Birda","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, All India Institute of Medical Sciences, Jodhpur, 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