A71 ASSOCIATION OF PREOPERATIVE CORTICOSTEROID USE WITH ADVERSE POSTOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ILEAL POUCH ANAL ANASTOMOSIS FOR ULCERATIVE COLITIS
Bibliographic record
Abstract
Inflammatory bowel disease (IBD) patients are frequently treated with steroids prior to surgery. Steroid use has been associated with perioperative complications We characterized the association between preoperative steroid use and postoperative complications in a large prospective cohort of IBD patients undergoing single-step ileal pouch anal anastomosis (IPAA). We identified ulcerative colitis patients who underwent open or laparoscopic colectomy with IPAA surgery in the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) between 2005 and 2012. We compared the risk of postoperative complications and 30-day mortality between preoperative steroid users and non-users. A total of 2736 patients were included in the analysis: 1623 (59.3%) were male, mean age at the time of surgery was 41 years (standard deviation, SD = 14), and the majority of patients had ulcerative pancolitis (89.9%). Laparoscopic surgery was used in 965 (35.3%) cases. Preoperative steroid use was encountered in 1104 (40.4%) patients. Preoperative steroid use was associated with higher rate of major (26.2% vs. 19.4%, p <0.001) and overall (32.7% vs. 26.2%, p <0.001) postoperative complications as well as a higher 30-day re-operation rate (8.2% vs. 5.6%, p = 0.006) and a slightly longer mean length of stay (8.1 vs. 7.5 days, p = 0.004). After adjustment for age, sex, smoking status, body mass index, functional status, preoperative weight loss and anemia, coexisting diabetes, and emergent status, preoperative steroid use was associated with higher risk of postoperative complications (OR, 1.48; 95% CI: 1.23–1.78, p <0.001). The difference was driven by higher rate of infectious complications (34.1% vs. 28.2%, p <0.001) and venous thromboembolism (VTE, 6.1% vs. 2.9%, p <0.001) in steroid users. Thirty-day readmission rate (16.1% vs. 16.4%, p = 0.981) and mortality rate (0.4% vs. 0.1%, p = 0.184) did not differ significantly between steroid users and non-users. The use of preoperative steroids is associated with a higher risk of postoperative sepsis and VTE in ulcerative colitis patient undergoing colectomy and single-step IPAA. Increased infection control measures and VTE prophylaxis may reduce adverse events in these patients. None
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".