PTH-043 Anastomotic leak rate after intestinal resection for crohn’s: does pathological subtype make a difference?
Bibliographic record
Abstract
Introduction Three out of four Crohn’s patients will undergo intestinal resection.1There are identified risks for post operative complications before their procedure such as malnutrition, abscess, obstruction, and pre operative therapies such as steroids and immunomodulators.2 The Montreal system3of classification attempts to assess disease severity and guide treatment. It divides Crohn’s into pathological subtypes of non penetrating/non stricturing, stricturing and penetrating. Evidence is limited as to the influence of Crohn’s subtype on anastomotic leak rate following bowel resection; however, it is felt penetrating Crohn’s may have higher risk of anastomotic leak. Our aim was to determine if this is the case. Method We collected retrospective data on all Crohn’s patients undergoing elective and emergency intestinal resection and anastamosis from March 2008–2014. 64 patients were identified and clinical records analysed for pathological subtype, operation/resection performed with a primary outcome of anastomotic leak. For tests of independence in discrete data fisher’s exact test was used. A p value of <0.05 was deemed statistically significant. Results We identified 33 males and 31 females with an age range of 15–86 years (mean 45 years). 27 (42%) were emergency procedures ad 37(58%) were elective. The most common procedure was right hemicolectomy (59%) followed by small bowel resection (25%). Pathology demonstrated 19 cases (30%) of penetrating and 15(23%) cases of stricturing disease. The remaining 30(47%) were non stricturing/non penetrating. There were 4 post operative anastomotic leaks, all within the penetrating disease group. This was statistically significant when compared to the stricturing and non stricturing/non penetrating groups (p = 0.006). Conclusion Our small study adds evidence to the suggestion that penetrating Crohn’s subtype is associated with anastomotic leak after intestinal resection. Surgeons operating on Crohn’s patients should be aware of this association and have a high index of suspicion for anastomotic complication in this group. Further study with larger numbers should be performed. Disclosure of interest None Declared. References Gardiner et al. Operative management of small bowel Crohn’s disease. Surg Clin N Am 2007;87:587–610 Samimi et al. Outcome of medical treatment of stricturing and penetrating Crohn’s disease: a retrospective study. Inflamm Bowel Dis 2010;16:1187–1194 Silverberg et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19(Suppl A):5A–36A
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".