The Role of Preoperative Internal Medicine Consultations for Ulcerative Colitis Patients Undergoing Colectomies
Bibliographic record
Abstract
Purpose: Despite advances in medical therapy, a colectomy is performed in approximately 30-40% of patients with ulcerative colitis (UC). Internists are often asked to evaluate a patient prior to surgery in order to determine the patient's risks in the proposed procedure. UC is associated with numerous extra-intestinal manifestations such as arthritis, primary sclerosing cholangitis, thromboembolic disease, and asthma. Furthermore, postoperative complications occur commonly (˜30%) following colectomy for UC. Thus, preoperative internal medicine consults may influence postoperative outcomes. The purpose of this study was to determine the prevalence of preoperative internal medicine consults for UC patients undergoing colectomy and evaluate the patient characteristics that predict referral for preoperative internal medicine consultation. Methods: Population-based surveillance was conducted in the Calgary Health Region between January 1, 1996 and December 31, 2007 using administrative databases to identify all adults (≥18 years) with ICD-9/10 coding for UC and a colectomy (n=582). All medical charts were reviewed. The primary outcome was the presence of a preoperative internal medicine consult prior to the operation. Logistic regression analysis was used to determine independent predictors of patients receiving a preoperative internal medicine consult. Point estimates were presented as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: Among the 582 UC patients who underwent a colectomy, 23% received a preoperative internal medicine consult. The median age at operation was 40 years (interquartile range: 30-53 years), 60% were males, 40% were current or ex-smokers, and 44% had no preoperative comorbidities. Independent predictors of preoperative internal medicine consults included age (64 years versus 18-34 years: OR 4.51, 95% CI: 2.16-9.4), comorbidities (>2 comorbidities vs. none: OR 6.76, 95% CI: 3.39-13.49), and indication of surgery was cancer (OR 2.01, 95% CI: 1.01-3.99). Conclusion: The majority of UC patients who undergo colectomy did not receive a preoperative internal medicine consult. Preoperative consults were predominantly requested for elderly patients with underlying comorbidities and UC patients who were operated for colorectal cancer. Future studies are necessary to determine whether wider spread use of preoperative internal medicine consults would improve postoperative outcomes.
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".