Canadian Association of General Surgeons and American College of Surgeons Evidence-Based Reviews in Surgery. 24. Fast-track programs in colonic surgery. Systematic review of enhanced recovery programmes in colonic surgery.
Bibliographic record
Abstract
Objective: To compare fast-track (FT) perioperative programs for elective colonic resections with traditional care. Data source: Studies were identified by searching the Cochrane Library, MEDLINE and EMBASE; as well, relevant journals and conference proceedings and electronic links to related articles were hand-searched, and investigators were contacted. Study selection: Studies were included if they were randomized or clinical controlled trials comparing a multimodal FT perioperative care program with traditional care in patients undergoing elective colon resections for malignant and benign diseases. Outcome measures: Outcome measures were the number of applied FT elements, hospital stay, readmission rate, morbidity and mortality. Results: Six trials containing 512 patients were included. FT programs contained a mean of 9 (range 4–12) of the 17 FT elements. For the outcome primary hospital stay, the results of 3 randomized controlled trials favoured the FT approach (weighted mean difference –1.56 d, 95% confidence interval [CI] –2.61 to –0.50). For the outcome readmission rate, 2 randomized controlled trials had a pooled nonsignificant relative risk (RR) of 0.42 (95% CI 0.14–1.27). Data were pooled from the 6 studies and showed significantly less morbidity in the FT group (RR 0.54, 95% CI 0.42–0.69). In both cases, the small sample size might have influenced the results. For morbidity and mortality, pooled data are not available, but the reviewers suggest that there is a trend toward lower mortality and morbidity in the FT group. In the nonrandomized trials, only 2 of 3 studies reported prim ary hospital stay, and the lack of difference in 1 study makes the weighted mean difference reported in the review reflective of only 1 estimate. Readmission rates were not consistent between studies, which is evident in the wighted mean difference of 1.55 days (95% CI 0.91–2.66). Results for morbidity and mortality are not reported in detail, but the reviewers suggest that there is a trend favouring FT perioperative care. Conclusions: The authors conclude the following: FT appears to be safe and shortens hospital stay after elective colorectal surgery. However, as the evidence is limited, a multicentre randomized trial seems justified.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.088 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.008 |
| Bibliometrics | 0.041 | 0.045 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.015 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".