Post-operative Outcomes Following Urgent and Elective Surgery for Ulcerative Colitis: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Ulcerative colitis (UC) is a chronic inflammatory condition affecting the large bowel. Surgery remains an important cornerstone in the treatment framework for UC, both in the elective setting for patients refractory to medical management and in the urgent setting for patients with acute severe UC. The aim of this study is to better define the risks associated with urgent surgery for acute severe UC when compared with elective surgery. This would allow clinicians to better outline the risks associated with urgent and elective bowel resections for UC and enable patients to make more informed decisions. A systematic review of the PubMed database was conducted independently by two authors looking at post-operative outcomes following bowel resection for UC within the elective and urgent settings. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion and exclusion criteria were pre-established using the Population, Intervention, Comparison, Outcome and Study (PICOS) framework. The primary outcome was 30-day mortality post-operatively and secondary outcomes were infection and re-operation rates following elective and urgent surgery. Bias was assessed using the Newcastle-Ottawa Score. A random effects meta-analysis was carried out. The absolute risk difference was calculated with 95% confidence intervals and p values for each of the primary and secondary outcomes. The systematic review yielded nine studies which were ultimately included within the meta-analysis. Infection rates following operation were included in two of these studies. Re-operation rates were included in four of these studies. A total of 5797 patients underwent urgent surgery and 12479 patients underwent elective surgery across the nine articles. Eight studies had a low risk of bias and one study had a medium risk of bias when assessed against the Newcastle-Ottawa Score. Overall, there was a 4.8% increased risk of mortality at 30 days post-operatively following urgent surgery when compared to elective surgery (Risk Difference (RD) = 0.048, 95% CI [0.027; 0.069], p < 0.001). This was statistically significant but the data showed significant heterogeneity (Q = 66.6, I2 = 88%). There was a 13% increased risk of post-operative infection with urgent surgery compared to elective surgery; however, this was not statistically significant (RD = 0.13, 95% CI [-0.01; 0.27], p = 0.20). There was a 4.5% increased risk of re-operation with urgent surgery; however, this was not statistically significant (RD = 0.045, 95% CI [-0.018; 0.109], p = 0.48). Patients undergoing urgent bowel resection surgery for UC therefore face a greater risk of mortality at 30 days post-operatively compared to elective surgery. This may be explained by patients in the acute setting being more de-conditioned and co-morbid than their elective counterparts. There was no statistically significant difference in rates of post-operative infection and return to the operating theatre following urgent versus elective surgery for UC. This could be due to better medical treatments allowing for better pre-operative planning and involvement of the multi-disciplinary team in the acute setting. Ultimately, the results from this study provide a reference frame for clinicians when managing patients with UC.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,014 | 0,037 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,018 | 0,042 |
| Bibliométrie | 0,007 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».