No difference in postoperative outcome after acute surgery whether the patients presented for first time or are known with Crohn's disease

Purposes: Acute operations (within 48 h) or urgent (within 2–7 days) carry the risk of unfavorable outcome as the patient is not optimized, the operation is performed by trainees and the disease is severe necessitating acute/urgent intervention. However, Crohn's disease (CD) patients who present as acute disease may have more favorable outcome because they did not receive medications, surgery is performed early and the disease is promptly controlled. Aim: To investigate whether CD patients presented first time have more favorable outcome compared to those who are known with CD. Method: Retrospective multi-center study. Rate of complications, duration of hospitalization and rate of re-admission were used as a measure of postoperative outcome. Univariate and multi-variate analyses were used. Results: Sixty-one patients in whom acute CD was first presentation (group 1) did not have more favorable outcome compared to 167 patients known to have CD (group 2) and presented acute. Mean duration of hospitalization was 8.7 days in group 1 compared to 9.4 days in group 2. Complications occurred in 12/61 patients (19.7%) in group 1 compared to 39/167 patients (23.4%) in group 2: odds ratio 1 .113, CI [0.611–2.024]. No difference in intra-abdominal septic complications rate was found between the two groups: odds ratio 0.932, CI [0.369–2.355]. Re-admission was seen in six patients (9.8%) in group 1 vs. 23 (13.8%) in Group 2: odds ratio 1.464, CI [0.566–3.788]. Conclusion: Patients undergoing acute surgery for the first CD presentation did not have more favorable outcome compared to those undergoing acute intestinal resection for known CD

A systematic review of pre, peri and postoperative factors and their implications for the lengths of resected bowel segments in patients with Crohn's disease

Aim: Several pre, peri and postoperative factors may have implications for the lengths of resected small bowel segments in Crohn's disease patients. It might also affect patient outcome. We reviewed the current literature on factors and their implications for the lengths of resected small bowel segments and possible correlations with postoperative outcome. Method: Searches were independently engineered by the authors and a research-librarian in MEDLINE and OVID databases using PubMed and EMBASE engines in compliance with PRISMA recommendations. All original articles, reviews and guidelines published in the period of 1985–2016 with last search date 13th of February 2016 on bowel resection in Crohn's disease patients were assessed for inclusion. Results: We identified 52 studies for synthesis. Preoperative: Perforation as indication for surgery and increased visceral obesity may be factors resulting in longer lengths of resected small bowel segments. Administration of total parenteral nutrition might reduce resection lengths. Perioperative: No difference in resection lengths in elective versus acute surgery, laparoscopic versus open approaches or in case of intra-operative blood transfusions. Stapled anastomoses might conserve more bowel than sutured ones. Postoperative: The lengths of the resected small bowel segments most likely have no impact on recurrence rates. Conclusion: No pre, peri or postoperative factors were found to have definitive implications for the lengths of resected small bowel segments. Correlation between the lengths of resection and recurrence is weak

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intraabdominal abscess in patients with Crohn’s disease.

Background In patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD. Methods A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1–14 days, 15–30 days and more than 30 days) for comparison of outcomes. Results The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24–44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6–15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042). Conclusion Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.post-print664 K

Inflammatory Response in Patients With Crohn's Disease Compared With Ulcerative Colitis: Secondary Results of a Prospective Pilot Study

Lay Summary This study showed that patients with Crohn's disease react with more inflammation to surgery than patients with ulcerative colitis. This finding indicates that Crohn's patients may need more preparation before surgery, and more monitoring after it. Background The aim of this study was to compare the inflammatory response (IR) to surgery between patients with Crohn's disease (CD) and patients with ulcerative colitis (UC). Methods This study is a secondary analysis of data collected in a previous study by the authors. We included all adult patients who underwent elective surgery for CD and UC. The primary outcome variable was the difference in postoperative IR as measured by interleukin 6 (IL-6), interleukin 10 (IL-10), C-reactive protein (CRP), and the count of white blood cells (WBCs) in peripheral blood. Two-way repeated-measures analysis of variance with a mixed effect (disease type as the between-patient factor, and time as the within patient factor). Results We included 46 patients in this pilot study. Median age was 42.5 years (IQR 30.5-42.2), 25/46 were females (54.3. Patients with CD had a more marked IR to surgery compared with those with UC as shown by significant differences in levels of IL-6, IL-10, and CRP. Patients with CD were more often treated with postoperative epidural analgesia 17 (53.1 versus 1 (7.1, P = .009. Patients with colonic CD had a more intense IR to surgery than patients with UC after the same surgical resection. This significant trend continued when patients who underwent small bowel resection compared with those with colectomy. The changes in inflammatory markers and WBC counts from baseline to peak value were also higher in patients with CD indicating a more severe IR. However, there was a similar response in patients undergoing laparoscopic compared with open approaches Conclusions The postoperative IR was greater in patients with CD than those with UC. This is important to tackle in preoperative optimization as well as postoperative recovery protocols.Background: The aim of this study was to compare the inflammatory response (IR) to surgery between patients with Crohn's disease (CD) and patients with ulcerative colitis (UC). Methods: This study is a secondary analysis of data collected in a previous study by the authors. We included all adult patients who underwent elective surgery for CD and UC. The primary outcome variable was the difference in postoperative IR as measured by interleukin 6 (IL-6), interleukin 10 (IL-10), C-reactive protein (CRP), and the count of white blood cells (WBCs) in peripheral blood. Two-way repeated-measures analysis of variance with a mixed effect (disease type as the between-patient factor, and time as the within patient factor). Results: We included 46 patients in this pilot study. Median age was 42.5 years (IQR 30.5-42.2), 25/46 were females (54.3%). Patients with CD had a more marked IR to surgery compared with those with UC as shown by significant differences in levels of IL-6, IL-10, and CRP. Patients with CD were more often treated with postoperative epidural analgesia 17 (53.1%) versus 1 (7.1%), P =. 009. Patients with colonic CD had a more intense IR to surgery than patients with UC after the same surgical resection. This significant trend continued when patients who underwent small bowel resection compared with those with colectomy. The changes in inflammatory markers and WBC counts from baseline to peak value were also higher in patients with CD indicating a more severe IR. However, there was a similar response in patients undergoing laparoscopic compared with open approaches Conclusions: The postoperative IR was greater in patients with CD than those with UC. This is important to tackle in preoperative optimization as well as postoperative recovery protocols.</p

Algorithms to anonymize structured medical and healthcare data:A systematic review

Introduction: With many anonymization algorithms developed for structured medical health data (SMHD) in the last decade, our systematic review provides a comprehensive bird’s eye view of algorithms for SMHD anonymization. Methods: This systematic review was conducted according to the recommendations in the Cochrane Handbook for Reviews of Interventions and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eligible articles from the PubMed, ACM digital library, Medline, IEEE, Embase, Web of Science Collection, Scopus, ProQuest Dissertation, and Theses Global databases were identified through systematic searches. The following parameters were extracted from the eligible studies: author, year of publication, sample size, and relevant algorithms and/or software applied to anonymize SMHD, along with the summary of outcomes. Results: Among 1,804 initial hits, the present study considered 63 records including research articles, reviews, and books. Seventy five evaluated the anonymization of demographic data, 18 assessed diagnosis codes, and 3 assessed genomic data. One of the most common approaches was k-anonymity, which was utilized mainly for demographic data, often in combination with another algorithm; e.g., l-diversity. No approaches have yet been developed for protection against membership disclosure attacks on diagnosis codes. Conclusion: This study reviewed and categorized different anonymization approaches for MHD according to the anonymized data types (demographics, diagnosis codes, and genomic data). Further research is needed to develop more efficient algorithms for the anonymization of diagnosis codes and genomic data. The risk of reidentification can be minimized with adequate application of the addressed anonymization approaches. Systematic Review Registration: [http://www.crd.york.ac.uk/prospero], identifier [CRD42021228200].</p