Postoperative Mortality for the Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis of Population-Based Studies: ACG Fellow Award
Bibliographic record
Abstract
Introduction: Post-operative mortality following intestinal resection for the inflammatory bowel diseases (IBD) varies in literature. We performed a systematic review and meta-analysis of populationbased studies to establish the risk of post-operative mortality following intestinal resection for patients with IBD. Methods: We searched Medline, EMBASE, and PubMed for terms related to ulcerative colitis (UC), Crohn’s disease (CD), IBD, surgery, and mortality (1980-March 2014). Two reviewers independently screened 2,947 unique citations to identify 52 for review. The analysis included population-based studies published as articles (n=18) and abstracts (n=3) reporting mortality in post-operative IBD patients. Mortality estimates and 95% confidence intervals (CI) were separately pooled for Crohn’s disease (CD) and ulcerative colitis (UC) using a random effects model. The analysis was stratified based on emergent versus elective operations. To assess changes over time, the start year of the study was included as a continuous variable in a meta-regression model. Results: The overall post-operative mortality was 3.2% (95% confidence interval [CI] 2.5%-4.1%) in UC and was 1.8% (95% CI 1.1%-3.2%) in CD (Figure 1). Heterogeneity was observed between studies for both CD and UC (p<0.01). The risk of post-operative mortality significantly decreased over time for CD (p<0.01), but not for UC (p=0.13). Post-operative mortality in UC did not differ between Europe and North America; however, post-operative mortality in CD was lower in North America than Europe. In UC, the risk of post-operative mortality was significantly lower for elective (0.7% [95% CI 0.6%-0.9%]) versus emergent surgery (5.3% [95% CI, 3.8%-7.4%]). In CD, the risk of post-operative mortality was significantly lower for elective (0.6% [95% CI, 0.2%-1.7%)] versus emergent surgery (3.6% [95% CI, 1.8%-6.9%).Figure 1: Forest plot using random-effects models of all included studies for risk of overall postoperative mortality in (A) ulcerative colitis and (B) Crohn’s disease.Conclusion: Post-operative mortality following colectomy for UC is high, and the risk of death has not been decreasing. In contrast, post-operative mortality following intestinal resection for CD is lower than UC and has decreased over time. Future studies should focus on mitigating the risk of mortality following intestinal resection; particularly, among IBD patients undergoing emergent surgery.
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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 | 0.025 | 0.054 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.027 |
| Bibliometrics | 0.009 | 0.011 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| 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".