Impact of Preoperative Factors in Patients With IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program–Inflammatory Bowel Disease Collaborative Analysis

Hill, Susanna S.; Ottaviano, Kathryn; Palange, David; Chismark, A David; Valerian, Brian T.; Canete, Jonathan J.; Lee, Edward C.

doi:10.1097/dcr.0000000000002831

Cited by 4 publications

(3 citation statements)

References 41 publications

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“…Patients with IBD are reported to have a longer LOS after colorectal resection than patients with neoplasia or diverticulitis because of their chronic inflammatory state, which is often associated with malnutrition [ 21 , 22 ]. A recent report investigating the details of preoperative medical therapy and postoperative consequences revealed that features that prolong postoperative hospital stay include bleeding disorders, hypoalbuminemia, and ASA score 3–5 [ 23 ]. Our results also showed that the ASA score and age at the time of surgery were independent risk factors for LOS.…”

Section: Discussionmentioning

confidence: 99%

The Comprehensive Complication Index in Ulcerative Colitis: A Comparison with the Clavien‒Dindo Classification

Horio,

Uchino,

Igeta

et al. 2024

Inflamm Intest Dis

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Introduction: The comprehensive complication index (CCI), which weights all postoperative complications according to severity and integrates them into a single formula, has been reported as a new evaluation system. We aimed to compare the CCI with the Clavien‒Dindo Classification (CDC) to patients with ulcerative colitis (UC). Methods: Patients who underwent initial surgery for UC from April 2012 to March 2020 were included. The patients were classified into a length of stay (LOS) >30 days group or an LOS ≤30 days group. We performed a multivariate analysis of risk factors for LOS >30 days in the model with the factors identified in the univariate analysis plus the CCI (the CCI model) and plus CDC (the CDC model). An ROC curve was used to test the difference in the area under the curve (AUC) between the CCI model and the CDC model. Results: The median LOS was 21 days (IQR: 16-29 days), and the rate of LOS >30 days was 119/588 (20.2%). In the CCI model, age at the time of surgery (OR=1.24, 95% CI 1.07-1.45, p=0.01), ASA score ≥3 (OR=1.94, 95% CI 1.00-3.76, p=0.04), and CCI (OR=1.07, 95% CI 1.05-1.09; p<0.01) were identified as independent risk factors for LOS >30 days. The AUC value of the CCI model (0.86) was significantly better in relation to LOS > 30 days than that of the CDC model (0.82) (p =0.02). Conclusion: The CCI was a better measure of LOS than was the CDC and was found to be a useful indicator in UC.

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Section: Discussionmentioning

confidence: 99%

The Comprehensive Complication Index in Ulcerative Colitis: A Comparison with the Clavien‒Dindo Classification

Horio,

Uchino,

Igeta

et al. 2024

Inflamm Intest Dis

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“…Albumin levels are a significant indicator of nutritional status. 39,40 In comparison with the preoperative albumin levels of the two groups (38.01 AE 4.78 and 42.38 AE 3.8 g/L, respectively), the preoperative albumin level in the blood transfusion group was significantly lower than that in the control group (p < 0.05), possibly due to the patients' poorer nutritional status prior to surgery. Low albumin levels can lead to delayed wound healing and an increased risk of infection.…”

Section: Correlation Between Postoperative Blood Transfusion and Vari...mentioning

confidence: 91%

Development and Validation of a Machine Learning Algorithm to Predict the Risk of Blood Transfusion after Total Hip Replacement in Patients with Femoral Neck Fractures: A Multicenter Retrospective Cohort Study

Zhu,

Xu,

Jiang

et al. 2024

Orthopaedic Surgery

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ObjectiveTotal hip arthroplasty (THA) remains the primary treatment option for femoral neck fractures in elderly patients. This study aims to explore the risk factors associated with allogeneic blood transfusion after surgery and to develop a dynamic prediction model to predict post‐operative blood transfusion requirements. This will provide more accurate guidance for perioperative humoral management and rational allocation of medical resources.MethodsWe retrospectively analyzed data from 829 patients who underwent total hip arthroplasty for femoral neck fractures at three third‐class hospitals between January 2017 and August 2023. Patient data from one hospital were used for model development, whereas data from the other two hospitals were used for external validation. Logistic regression analysis was used to screen the characteristic subsets related to blood transfusion. Various machine learning algorithms, including logistic regression, SVA (support vector machine), K‐NN (k‐nearest neighbors), MLP (multilayer perceptron), naive Bayes, decision tree, random forest, and gradient boosting, were used to process the data and construct prediction models. A 10‐fold cross‐validation algorithm facilitated the comparison of the predictive performance of the models, resulting in the selection of the best‐performing model for the development of an open‐source computing program.ResultsBMI (body mass index), surgical duration, IBL (intraoperative blood loss), anticoagulant history, utilization rate of tranexamic acid, Pre‐Hb, and Pre‐ALB were included in the model as well as independent risk factors. The average area under curve (AUC) values for each model were as follows: logistic regression (0.98); SVA (0.91); k‐NN (0.87) MLP, (0.96); naive Bayes (0.97); decision tree (0.87); random forest (0.96); and gradient boosting (0.97). A web calculator based on the best model is available at: (https://nomo99.shinyapps.io/dynnomapp/).ConclusionUtilizing a computer algorithm, a prediction model with a high discrimination accuracy (AUC > 0.5) was developed. The logistic regression model demonstrated superior differentiation and reliability, thereby successfully passing external validation. The model's strong generalizability and applicability have significant implications for clinicians, aiding in the identification of patients at high risk for postoperative blood transfusion.

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“…In a very recently published study of a large number of patients (1710 with CD and 1291 with UC), it was found that clinically significant factors contributing to increased postoperative length of hospital stay were rectal surgery, creation of a new ileostomy, preoperative hospitalization, hypoalbuminemia and the presence of bleeding disorder. Of interest was the finding that chronic use of corticosteroids, immunosuppressants, and biological agents including orally administered small molecule drugs, was insignificant[ 13 ]. Another clinical question concerns the possible relationship between serum infliximab (IFX) levels and the presence of endoscopic recurrence in patients undergoing cecal and ileal resection for CD.…”

Section: Surgery For Small Bowel CDmentioning

confidence: 99%

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

Triantafillidis

2024

World J Gastrointest Surg

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Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) represents, in the majority of cases, a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience. During the last two decades, our pharmaceutical arsenal was significantly strengthened, especially after the introduction of the so-called biological agents, drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease. However, colectomy is still necessary for some patients with severe UC although smaller compared to the past, precisely because of the improvements achieved in the available conservative treatment. Nevertheless, surgeries to treat colon dysplasia and cancer are increasing to some extent. At the same time, satisfactory improvements in surgical techniques, the pre-and post-operative care of patients, as well as the selection of the appropriate time for performing the surgery have been noticed. Regarding patients with CD, the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease. On the other hand, the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible. This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view, the results of the emerging new techniques such as transanal surgery and robotics, as well as alternative operations to the classic ileo-anal-pouch anastomosis. The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature. The self-evident is emphasized, that is, to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era; the close cooperation of gastroenterologists with surgeons, pathologists, imaging, and nutritionists is of paramount importance.

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Impact of Preoperative Factors in Patients With IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program–Inflammatory Bowel Disease Collaborative Analysis

Cited by 4 publications

References 41 publications

The Comprehensive Complication Index in Ulcerative Colitis: A Comparison with the Clavien‒Dindo Classification

The Comprehensive Complication Index in Ulcerative Colitis: A Comparison with the Clavien‒Dindo Classification

Development and Validation of a Machine Learning Algorithm to Predict the Risk of Blood Transfusion after Total Hip Replacement in Patients with Femoral Neck Fractures: A Multicenter Retrospective Cohort Study

Surgical treatment of inflammatory bowel disease: From the gastroenterologist’s stand-point

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