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Article ; Online: Supervised Bayesian Statistical Learning to Identify Prognostic Risk Factor Patterns from Population Data.

Crooks, Colin J

Studies in health technology and informatics

2020 Volume 270, Page(s) 422–426

Abstract: Current methods for building risk models assume averaged uniform effects across populations. They use weighted sums of individual risk factors from regression models with only a few interactions, such as age. This does not allow risk factor effects to ... ...

Abstract	Current methods for building risk models assume averaged uniform effects across populations. They use weighted sums of individual risk factors from regression models with only a few interactions, such as age. This does not allow risk factor effects to vary in different morbidity contexts. This study modified a supervised Bayesian statistical learning method of topic modelling, allowing individual factors to have different effects depending on a patient's other comorbidity. This study used topic modelling to assess more than 71,000 unique risk factors in a population cohort of 1.4 million adults within routine data. The model learnt prognostically important risk factor patterns that predicted 5 year survival, and the resulting model achieved excellent calibration and discrimination with a C statistic of 0.9 in a held out validation cohort. The model explained 92% of the observed variation in 5 year survival in the population. This paper validates using survival supervised Bayesian topic modelling within large routine electronic population health data to identify prognostically important risk factor patterns.
MeSH term(s)	Bayes Theorem ; Calibration ; Cohort Studies ; Humans ; Prognosis ; Risk Factors
Language	English
Publishing date	2020-06-20
Publishing country	Netherlands
Document type	Journal Article
ISSN	1879-8365
ISSN (online)	1879-8365
DOI	10.3233/SHTI200195
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Article ; Online: Ethnicity and socio-economic status affects the incidence and survival of hepatosplenic T-cell lymphoma.

Bishton, Mark J / Crooks, Colin J / Card, Timothy R / West, Joe

British journal of haematology

2024

Abstract: To address the lack of contemporary population-based epidemiological studies of hepatosplenic T-cell lymphoma (HSTCL), we undertook a population-based study of ICD-O-3-coded HSTCL in England. We used the National Cancer Registration Dataset and linked ... ...

Abstract	To address the lack of contemporary population-based epidemiological studies of hepatosplenic T-cell lymphoma (HSTCL), we undertook a population-based study of ICD-O-3-coded HSTCL in England. We used the National Cancer Registration Dataset and linked datasets on hospital admissions, Systemic Anti-Cancer Therapy, socio-demographics, comorbidities and death, identifying cases from 1 January 2013 to 31 December 2019 with survival data up to 5 January 2021. Crude and directly age-standardised incidence rates per million persons per year were calculated. Crude and adjusted incidence rate ratios compared incidence between groups using Poisson regression. A Cox proportional hazards model estimated mortality risks adjusted for age, sex, ethnicity, deprivation and allogenic stem cell transplant (allo-SCT; time varying). We identified 44 patients, mean age 42 years. Median survival was 11 months, and 1 and 5 year survivals were 48% (95% CI 29%-43%) and 22% (95% CI 12%-42%) respectively. The age-standardised incidence was 0.1 per million/year. Incidence was higher in areas with greater deprivation (0.15 per million/year), and more cases than expected were in non-White patients (39%). Non-Whites had a twofold increased risk of death (adjusted hazard ratio 2.21 [95% CI 1.03-4.78]) even after adjusting for deprivation, younger age and allo-SCT. In conclusion, ethnicity and socio-economic status affect both the incidence and survival of HSTCL.
Language	English
Publishing date	2024-02-29
Publishing country	England
Document type	Journal Article
ZDB-ID	80077-6
ISSN	1365-2141 ; 0007-1048
ISSN (online)	1365-2141
ISSN	0007-1048
DOI	10.1111/bjh.19371
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Article ; Online: The effect of diabetes mellitus on perioperative outcomes after colorectal resection: a national cohort study.

Gysling, Savannah / Lewis-Lloyd, Christopher A / Lobo, Dileep N / Crooks, Colin J / Humes, David J

British journal of anaesthesia

2024

Abstract: Background: Diabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes after colorectal ... ...

Abstract	Background: Diabetes mellitus is a significant modulator of postoperative outcomes and is an important risk factor in the patient selection process. We aimed to investigate the effect of diabetes mellitus and use of insulin on outcomes after colorectal resection using a national cohort. Methods: Adults with a recorded colorectal resection in England between 2010 and 2020 were identified from Hospital Episode Statistics data linked to the Clinical Practice Research Database. The primary outcome was 90-day mortality. Secondary outcomes included hospital length of stay (LOS) and readmission within 90 days. Results: Of the 106 139 (52 875, 49.8% male) patients included, diabetes mellitus was prevalent in 10 931 (10.3%), 2145 (19.6%) of whom had a record of use of insulin. Unadjusted 90-day mortality risk was 5.7%, with an increased adjusted hazard ratio (aHR) for people with diabetes mellitus (aHR 1.28, 95% confidence interval [CI] 1.19-1.37, P<0.001). This risk was higher in both people with diabetes using insulin (aHR 1.51, 95% CI 1.31-1.74, P<0.001) and not using insulin (aHR 1.22, 95% CI 1.13-1.33, P<0.001), compared with those without diabetes. Ninety-day readmission occurred in 20 542 (19.4%) patients and this was more likely in those with diabetes mellitus (aHR 1.23, 95% CI 1.18-1.29, P<0.001). Median (inter-quartile range) LOS was 8 (5-15) days and was higher in people with diabetes mellitus (adjusted time ratio 1.10, 95% CI 1.08-1.11, P<0.001). Conclusions: People with diabetes mellitus undergoing colorectal resection are at a higher risk of 90-day mortality, prolonged LOS, and 90-day readmission, with use of insulin associated with additional risk.
Language	English
Publishing date	2024-05-16
Publishing country	England
Document type	Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2024.04.010
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Article ; Online: Editorial: seeing the light at the end of gastroscope - complications after elective procedures are ready for NICE, bright decision aid tools - authors' reply.

West, Joe / Card, Timothy R / Crooks, Colin J

Alimentary pharmacology & therapeutics

2022 Volume 56, Issue 1, Page(s) 157

MeSH term(s)	Crohn Disease/surgery ; Decision Support Techniques ; Elective Surgical Procedures/adverse effects ; Gastroscopes ; Humans
Language	English
Publishing date	2022-06-10
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.16987
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Article ; Online: The risk of unexpected hospital admissions and primary care visits after an elective day-case gastroscopy: a cohort study within England.

Crooks, Colin J / Card, Timothy R / West, Joe

Alimentary pharmacology & therapeutics

2022 Volume 56, Issue 1, Page(s) 56–66

Abstract: Aim: To determine the excess of acute medical contacts following a day-case diagnostic gastroscopy.: Methods: Cohort study using English linked primary, secondary care and death registry electronic health data. We included 277,535 diagnostic day-case ...

Abstract	Aim: To determine the excess of acute medical contacts following a day-case diagnostic gastroscopy. Methods: Cohort study using English linked primary, secondary care and death registry electronic health data. We included 277,535 diagnostic day-case gastroscopies in 225,304 people between 1998 and 2016 and followed up for 30 days. 1,383,535 30-day periods without a gastroscopy within 991,249 people frequency matched on year, gender and decade of birth. Non-cancer deaths, emergency non-cancer admissions and cardio, vascular or respiratory (CVR) primary care consultations were identified and adjusted for each other as competing risks. Outcomes related to possible indications for gastroscopy were censored. Results: 5.1% of day-case diagnostic gastroscopies were followed by emergency hospital admission, 0.4% for a CVR diagnosis. Adjusted for age, sex, morbidity, time trends, indications and competing risks, there was a 0.1% excess of CVR-related hospital admissions compared to controls. This reduced to 0.05% (95% confidence interval 0.04-0.06%) in people under 40 years without morbidity and increased to 1.1% (0.6%-1.6%) in people over 90 years with high comorbidity. Similarly, by 30 days, 3.8% had a primary care consultation for a CVR problem, with an excess after adjustment ranging from 0.13% (0.11%-0.16%) to 0.31% (0.14%-0.50%). Overall numbers needed to harm ranged from 1 in 294 gastroscopies to 1 in 67 gastroscopies. Conclusions: There was an excess of vascular and respiratory events associated with a diagnostic gastroscopy. In younger patients, this risk manifested as an increase in primary care consultations while in older patients there was an increase in emergency hospital admissions.
MeSH term(s)	Aged ; Cohort Studies ; Gastroscopy ; Hospitalization ; Hospitals ; Humans ; Primary Health Care
Language	English
Publishing date	2022-04-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639012-2
ISSN	1365-2036 ; 0269-2813 ; 0953-0673
ISSN (online)	1365-2036
ISSN	0269-2813 ; 0953-0673
DOI	10.1111/apt.16946
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Article: Smoking is a Risk Factor for Autoimmune Hepatitis: An English Registry-Based Case-Control Study.

Grønbæk, Lisbet / Omeife, Harmony / Ban, Lu / Crooks, Colin J / Card, Timothy R / Jepsen, Peter / West, Joe

Clinical epidemiology

2024 Volume 16, Page(s) 23–30

Abstract: Purpose: Smoking is a risk factor for some autoimmune diseases, but its association with autoimmune hepatitis remains unknown. We conducted a population-based matched case-control study to examine the association between tobacco smoking and the risk of ... ...

Abstract	Purpose: Smoking is a risk factor for some autoimmune diseases, but its association with autoimmune hepatitis remains unknown. We conducted a population-based matched case-control study to examine the association between tobacco smoking and the risk of autoimmune hepatitis in England. Patients and methods: From the Clinical Practice Research Datalink and linked Hospital Episode Statistics, 2005-2017, we included 987 cases diagnosed with autoimmune hepatitis after age 18 years and up to 10 frequency-matched population controls per case. We used multiple logistic regression to estimate the odds ratio of autoimmune hepatitis in ever-smokers vs never-smokers, adjusting for sex, age, general practice, calendar time of registration with the general practice, and socioeconomic status. Results: The autoimmune hepatitis cases were more likely to be ever-smokers than the controls (44% vs 37%). The ever-smokers had an increased risk of autoimmune hepatitis compared with the never-smokers (adjusted odds ratio = 1.20, 95% confidence interval 1.03-1.39). Conclusion: Smoking was associated with an increased risk of autoimmune hepatitis.
Language	English
Publishing date	2024-01-31
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2494772-6
ISSN	1179-1349
ISSN	1179-1349
DOI	10.2147/CLEP.S439219
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Article ; Online: Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis.

Leow, Tjun Wei / Rashid, Adil / Lewis-Lloyd, Christopher A / Crooks, Colin J / Humes, David J

Diseases of the colon and rectum

2023 Volume 66, Issue 7, Page(s) 877–885

Abstract: Background: Venous thromboembolism is a well-established preventable complication after colectomy. Specific guidance on venous thromboembolism prevention after colectomy for benign disease is limited.: Objective: This meta-analysis aimed to quantify ... ...

Abstract	Background: Venous thromboembolism is a well-established preventable complication after colectomy. Specific guidance on venous thromboembolism prevention after colectomy for benign disease is limited. Objective: This meta-analysis aimed to quantify the venous thromboembolism risk after benign colorectal resection and determine its variability. Data sources: Following Preferred Reporting Items for Systematic Review and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology Guidelines (PROSPERO: CRD42021265438), Embase, MEDLINE, and 4 other registered medical literature databases were searched from the database inception to June 21, 2021. Study selection: Inclusion criteria: randomized controlled trials and large population-based database cohort studies reporting 30-day and 90-day venous thromboembolism rates after benign colorectal resection in patients aged ≥18 years. Exclusion criteria: patients undergoing colorectal cancer or completely endoscopic surgery. Main outcome measures: Thirty- and 90-day venous thromboembolism incidence rates per 1000 person-years after benign colorectal surgery. Results: Seventeen studies were eligible for meta-analysis reporting on 250,170 patients. Pooled 30-day and 90-day venous thromboembolism incidence rates after benign colorectal resection were 284 (95% CI, 224-360) and 84 (95% CI, 33-218) per 1000 person-years. Stratified by admission type, 30-day venous thromboembolism incidence rates per 1000 person-years were 532 (95% CI, 447-664) for emergency resections and 213 (95% CI, 100-453) for elective colorectal resections. Thirty-day venous thromboembolism incidence rates per 1000 person-years after colectomy were 485 (95% CI, 411-573) for patients with ulcerative colitis, 228 (95% CI, 181-288) for patients with Crohn's disease, and 208 (95% CI, 152-288) for patients with diverticulitis. Limitations: High degree of heterogeneity was observed within most meta-analyses attributable to large cohorts minimizing within-study variance. Conclusions: Venous thromboembolism rates remain high up to 90 days after colectomy and vary by indication for surgery. Emergency resections compared to elective benign resections have higher rates of postoperative venous thromboembolism. Further studies reporting venous thromboembolism rates by type of benign disease need to stratify rates by admission type to more accurately define venous thromboembolism risk after colectomy. Registration no: CRD42021265438.
MeSH term(s)	Humans ; Adolescent ; Adult ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Retrospective Studies ; Colorectal Surgery ; Risk Factors ; Colectomy/adverse effects ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/complications ; Postoperative Complications/etiology
Language	English
Publishing date	2023-04-24
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002915
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Article ; Online: Venous thromboembolism following colectomy for diverticular disease: an English population-based cohort study.

Yapa, Anjali K D S / Humes, David J / Crooks, Colin J / Lewis-Lloyd, Christopher A

Langenbeck's archives of surgery

2023 Volume 408, Issue 1, Page(s) 203

Abstract: Aim: This study reports venous thromboembolism (VTE) rates following colectomy for diverticular disease to explore the magnitude of postoperative VTE risk in this population and identify high risk subgroups of interest.: Method: English national ... ...

Abstract	Aim: This study reports venous thromboembolism (VTE) rates following colectomy for diverticular disease to explore the magnitude of postoperative VTE risk in this population and identify high risk subgroups of interest. Method: English national cohort study of colectomy patients between 2000 and 2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type, absolute incidence rates (IR) per 1000 person-years and adjusted incidence rate ratios (aIRR) were calculated for 30- and 90-day post-colectomy VTE. Results: Of 24,394 patients who underwent colectomy for diverticular disease, over half (57.39%) were emergency procedures with the highest VTE rate seen in patients ≥70-years-old (IR 142.27 per 1000 person-years, 95%CI 118.32-171.08) at 30 days post colectomy. Emergency resections (IR 135.18 per 1000 person-years, 95%CI 115.72-157.91) had double the risk (aIRR 2.07, 95%CI 1.47-2.90) of developing a VTE at 30 days following colectomy compared to elective resections (IR 51.14 per 1000 person-years, 95%CI 38.30-68.27). Minimally invasive surgery (MIS) was shown to be associated with a 64% reduction in VTE risk (aIRR 0.36 95%CI 0.20-0.65) compared to open colectomies at 30 days post-op. At 90 days following emergency resections, VTE risks remained raised compared to elective colectomies. Conclusion: Following emergency colectomy for diverticular disease, the VTE risk is approximately double compared to elective resections at 30 days while MIS was found to be associated with a reduced risk of VTE. This suggests advancements in postoperative VTE prevention in diverticular disease patients should focus on those undergoing emergency colectomies.
MeSH term(s)	Humans ; Aged ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Cohort Studies ; Risk Factors ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Colectomy/adverse effects ; Colectomy/methods ; Diverticular Diseases/epidemiology ; Diverticular Diseases/surgery ; Diverticular Diseases/complications
Language	English
Publishing date	2023-05-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-023-02920-6
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Article ; Online: Incidence and Survival in Patients With Enteropathy-associated T-Cell Lymphoma: Nationwide Registry Studies From England and Denmark.

West, Joe / Jepsen, Peter / Card, Timothy R / Crooks, Colin J / Bishton, Mark

Gastroenterology

2023 Volume 165, Issue 4, Page(s) 1064–1066.e3

MeSH term(s)	Humans ; Enteropathy-Associated T-Cell Lymphoma/epidemiology ; Enteropathy-Associated T-Cell Lymphoma/complications ; Incidence ; Registries ; England/epidemiology ; Denmark/epidemiology
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	80112-4
ISSN	1528-0012 ; 0016-5085
ISSN (online)	1528-0012
ISSN	0016-5085
DOI	10.1053/j.gastro.2023.06.003
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Article ; Online: Cholecystectomy in patients with cirrhosis: a population-based cohort study from England.

Adiamah, Alfred / Crooks, Colin J / Hammond, John S / Jepsen, Peter / West, Joe / Humes, David J

HPB : the official journal of the International Hepato Pancreato Biliary Association

2022 Volume 25, Issue 2, Page(s) 189–197

Abstract: Background: This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis.: Methods: Linked electronic healthcare data from England were used to identify all ... ...

Abstract	Background: This population-based cohort study aimed to determine postoperative outcomes after emergency and elective cholecystectomy in patients with cirrhosis. Methods: Linked electronic healthcare data from England were used to identify all patients undergoing cholecystectomy between January 2000 and December 2017. Length of stay (LOS), re-admission, case fatality and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex and co-morbidity using logistic regression. Results: Of the total 69,141 eligible patients who underwent a cholecystectomy, 511 (0.74%) had cirrhosis. In patients without cirrhosis 86.55% underwent a laparoscopic procedure compared with 57.53% in patients with cirrhosis (p < 0.0001). LOS was longer in those with cirrhosis (3 IQR 1-8 vs 1 IQR 1-3 days,p < 0.0001). 90-day re-admission was greater in patients with cirrhosis, 36.79% compared with 14.95% in those without cirrhosis. 90-day case fatality after elective cholecystectomy in patients with and without cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following emergency cholecystectomy. This equated to a 3-fold (OR 3.22, IQR 1.72-6.02) and a 4-fold (OR 4.52, IQR 2.46-8.33) increased odds of death at 90-days following elective and emergency cholecystectomy after adjusting for confounders. Conclusion: Patients with cirrhosis undergoing cholecystectomy have an increased 90-day risk of postoperative mortality, which is significantly worse after emergency procedures.
MeSH term(s)	Humans ; Cholecystectomy, Laparoscopic ; Cohort Studies ; Cholecystectomy ; Liver Cirrhosis ; England ; Length of Stay ; Retrospective Studies
Language	English
Publishing date	2022-08-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2022.08.006
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