Abstract Background Fistulising Crohn’s disease (fCD) affects up to 40% of people with Crohn’s disease (CD) over their lifetime, leading to perianal pain, faecal incontinence and sepsis. Despite its high prevalence, the burden of disease, treatment and “natural history” in the current biologic therapy era are poorly described. This study explored demographics, disease and treatment factors in a real-world cohort Methods The clinical quality registry (CQR) is created from deidentified data flowing into a registry during documentation in routine care. The CQR was interrogated in December 2022. People with CD with a care encounter in the last 14 months at one of 20 treating centres were included (n=3039). People with a current fistula were defined as those with an actively draining fistula on most recent clinical assessment, radiologic or endoscopic investigation. Previous fCD was defined as the prior presence of a fistula with most recent documentation showing resolution Results There were 3039 people with CD with a mean age of 43.1 years (SD +/- 16.23). 49% of the total CD cohort were female with a mean disease duration of 13.7 years (SD +/- 10.1). 532 (17.5%) people with CD had fCD documented in the CQR, with 220 current and 312 previous fCD. People with current or previous fCD were younger than those with no prior fistulising disease (40.5 & 39.6 vs 44.1, p=0.005 & p<0.001). Male gender was more commonly seen in those with current (58% p=0.022) or previous fCD (58% p=0.007) compared to those with no prior fCD (50% n=1270) People with current and previous fCD had higher rates of current biologic use compared to those with no prior fCD recorded (75.5% & 68.3% vs 48.9%, p<0.001 & p<0.001, respectively). Of those on biologic therapy, people with current or previous fistula were more likely to be on anti-TNF therapy (Adalimumab or Infliximab) compared to those with no history of fCD (85.5% & 82.2% vs 68.1%; p<0.001 & p<0.001 respectively). People with active or previous fCD were less likely to have ever been on steroid therapy compared to those without a history of fistulising disease (23.6%, 24.4% & 32.3%, p<0.001 & p<0.001) People with current or previous fCD had higher rates of CD-related hospital admissions compared to those without a history of fCD (5% & 6% vs 1.9%, p<0.001 and p<0.001 respectively). People with previous fistulising disease had higher rates of surgery within the last 12 months compared to people with no prior fCD (21.2% vs 13.3%, p<0.001) Conclusion People with current and previous fCD continue to experience higher hospitalisation rates for disease related complications and more frequently require surgical procedures. This highlights the importance of proactive management of fCD to reduce morbidity and avoidable healthcare utilisation