Rates of post-operative Crohn's disease (CD) recurrence remain high, although the ability to predict this risk of recurrence remains limited. As such, we aimed to determine the association of histological features at time of resection with post-operative recurrence.Electronic databases were searched through February 2020 for studies that reported risk of clinical, endoscopic, or surgical post-operative recurrence in patients with positive resection margins, plexitis, or granulomas in the index specimen. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated for this risk in patients with and without these histological features.Twenty-one studies (2481 patients) assessed positive resection margins, 10 studies (808 patients) assessed plexitis, and 19 studies (1777 patients) assessed granulomas. Positive resection margins increased the risk of clinical (RR 1.26, 95% CI, 1.06-1.49, I2=41%) and surgical (RR 1.87, 95% CI, 1.14-3.08, I2=71%) recurrence, with a trend towards endoscopic recurrence (RR 1.56, 95% CI, 0.79-3.05, I2=85%). Granulomas increased the risk of clinical (RR 1.31, 95% CI, 1.05-1.64, I2=36%) and endoscopic (RR of 1.37, 95% CI, 1.00-1.87, I2=49%) recurrence, with a trend towards surgical recurrence (RR 1.58, 95% CI, 0.89-2.80, I2=75%). Plexitis increased the risk of endoscopic recurrence (RR 1.31, 95% CI, 1.00-1.72, I2=20%), with a trend towards clinical recurrence (RR of 1.34, 95% CI, 0.95-1.91, I2=46%).Positive resection margins, granulomas, and plexitis are predictive of post-operative CD recurrence and should be recorded at time of index resection.