Improving Surgical Outcomes in Pediatric Inflammatory Bowel Disease (IBD-SETON)

Project start and end dates: 2019 – present
(AHRQ R01 active 2023 – 2028)

Background:
Children with Crohn’s disease and ulcerative colitis experience substantial morbidity related to surgical complications, timing of surgery, and perianal fistulizing disease. Prior to this work, there was marked inter-center variation and lack of standardized surgical algorithms for pediatric IBD.

Objectives:

• Standardize surgical evaluation and management of pediatric IBD across centers
• Reduce steroid exposure and perianal fistula development
• Evaluate timing and approach to restorative proctocolectomy and pouch creation
• Measure outcomes and variation in care across institutions

Research Topics & Methods:

• Multicenter outcomes and health services research
• Retrospective and prospective cohort studies
• Network-based quality improvement within ImproveCareNow
• Comparative effectiveness analyses (medical vs surgical strategies)

Implications:
This work directly informs national guidelines for pediatric IBD surgery, reduces complications, and improves long-term outcomes through evidence-based, standardized care pathways.

Funders:

• Agency for Healthcare Research and Quality (AHRQ), R01 (MPI)
• Institutional support through CHEAR and ImproveCareNow

Collaborators:
Jeremy Adler, ImproveCareNow Clinical Committee, IBD-SETON investigators, pediatric gastroenterology and surgery collaborators nationally.

Key Publications:

• Adler J, Gadepalli S, et al. Early TNF antagonist treatment prevents perianal fistula development in children with Crohn’s disease. Gut. 2025;74:539-546. PMID:39667905
• Rubalcava NS, Gadepalli SK, et al. Single-stage restorative proctocolectomy for ulcerative colitis in pediatric patients. Pediatr Surg Int. 2021. PMID:34143272
• Rubalcava NS, Gadepalli SK, et al. Timing of pouch creation in 2-stage operations for pediatric UC. J Pediatr Surg. 2021. PMID:33741179
• Adler J, Gadepalli SK, et al. Steroid-sparing therapy and perianal fistulizing risk. JAMA Netw Open. 2020. PMCID: PMC7284306