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

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