{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:06:59Z","timestamp":1786118819626,"version":"build-2736575974"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Inflammatory bowel disease (IBD), affecting over 2 million individuals in the United States, is associated with substantial morbidity, recurrent hospitalizations, and need for long-term immunosuppressive therapy. Although biologic therapies have been associated with declining operative rates in IBD, a clinically significant subset of patients continues to progress to surgery despite biologic exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study evaluated surgical intervention rates among patients with Crohn\u2019s disease (CD) and ulcerative colitis (UC) across two biologic treatment eras using the TriNetX Research Network, a multi-institutional database of de-identified electronic health records. Adult patients (ages 18-90) receiving biologic therapy were divided into two cohorts: 2004-2014 and 2014-2024. Surgical intervention following biologic initiation was used as a surrogate for treatment failure, and propensity score matching was performed to reduce confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, 9822 patients remained in each cohort. Surgical intervention occurred in 8.4% of patients in the earlier cohort compared with 5.9% in the contemporary cohort, corresponding to a 29.8% relative reduction in operative intervention (RR 1.426, 95% CI 1.285-1.583;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Patients in the earlier cohort also demonstrated significantly higher risk of surgery within 1 year of biologic initiation. Within the contemporary cohort, CD patients continued to demonstrate higher operative risk compared with UC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Contemporary biologic therapy was associated with reduced operative intervention over time; however, persistent operative burden remains despite biologic exposure, particularly among patients with CD and nutritional compromise.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261474196","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:29:52Z","timestamp":1785803392000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Who Still Needs Surgery? Defining the Modern Surgical Phenotype in Inflammatory Bowel Disease"],"prefix":"10.1177","author":[{"given":"Taylor E.","family":"Messick-Ngo","sequence":"first","affiliation":[{"name":"Riverside Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"Boyer","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Potalivo","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4019-5158","authenticated-orcid":false,"given":"Jasmine Kazemi","family":"Gwizdala","sequence":"additional","affiliation":[{"name":"University of California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Scally","sequence":"additional","affiliation":[{"name":"Riverside Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2076-2436","authenticated-orcid":false,"given":"Emily D.","family":"Dubina","sequence":"additional","affiliation":[{"name":"Riverside Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Sheets","sequence":"additional","affiliation":[{"name":"University of California"},{"name":"Riverside Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aras","family":"Emdadi","sequence":"additional","affiliation":[{"name":"Riverside Community Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6542a3"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.MIB.0000440983.86659.81"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2020.10.039"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izz315"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izad149"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.02.021"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izz247"},{"key":"e_1_3_3_9_2","volume-title":"Biologics versus immunomodulators for the treatment of ulcerative colitis: a review of comparative clinical effectiveness and cost-effectiveness","author":"Chao YS","year":"2019","unstructured":"Chao YS, Loshak H. Biologics versus immunomodulators for the treatment of ulcerative colitis: a review of comparative clinical effectiveness and cost-effectiveness. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2019. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK546098\/"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1907607"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-020-04832-y"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2018.12.022"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.394"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2023.03.003"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000003465"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1017\/S000711452400240X"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.07.041"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59020337"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2024-001371"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.4292\/wjgpt.v12.i5.90"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1177\/0884533616661844"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261474196","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261474196","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261474196","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T16:50:02Z","timestamp":1786035002000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261474196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":20,"alternative-id":["10.1177\/00031348261474196"],"URL":"https:\/\/doi.org\/10.1177\/00031348261474196","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"00031348261474196"}}