Prediction of Adverse Events in Patients Undergoing Major Cardiovascular Procedures

Electronic health records (EHR) provide opportunities to leverage vast arrays of data to help prevent adverse events, improve patient outcomes, and reduce hospital costs. This paper develops a postoperative complications prediction system by extracting data from the EHR and creating features. The analytic engine then provides model accuracy, calibration, feature ranking, and personalized feature responses. This allows clinicians to interpret the likelihood of an adverse event occurring, general causes for these events, and the contributing factors for each specific patient. The patient cohort considered was 5214 patients in Yale-New Haven Hospital undergoing major cardiovascular procedures. Cohort-specific models predicted the likelihood of postoperative respiratory failure and infection, and achieved an area under the receiver operating characteristic curve of 0.81 for respiratory failure and 0.83 for infection.

[1]  P. Spieth,et al.  Non-ventilatory approaches to prevent postoperative pulmonary complications. , 2015, Best practice & research. Clinical anaesthesiology.

[2]  Trevor Hastie,et al.  Regularization Paths for Generalized Linear Models via Coordinate Descent. , 2010, Journal of statistical software.

[3]  D. Gouma,et al.  Predictors of surgical complications: A systematic review. , 2015, Surgery.

[4]  Li Li,et al.  Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records , 2016, Scientific Reports.

[5]  Mark Braverman,et al.  Data-Driven Decisions for Reducing Readmissions for Heart Failure: General Methodology and Case Study , 2014, PloS one.

[6]  F. Xue,et al.  Analysis of risk factors, morbidity, and cost associated with respiratory complications following abdominal wall reconstruction. , 2015, Plastic and reconstructive surgery.

[7]  Tianqi Chen,et al.  XGBoost: A Scalable Tree Boosting System , 2016, KDD.

[8]  M. Schultz,et al.  Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis , 2013, Current opinion in anaesthesiology.

[9]  I. Toumpoulis,et al.  Does EuroSCORE predict length of stay and specific postoperative complications after cardiac surgery? , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[10]  J. Canet,et al.  Post-operative pulmonary complications: Understanding definitions and risk assessment. , 2015, Best practice & research. Clinical anaesthesiology.

[11]  Chris A Rogers,et al.  Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery , 2007, Circulation.

[12]  D. Collet,et al.  Major Post-Operative Complications Predict Long-Term Survival After Esophagectomy in Patients with Adenocarcinoma of the Esophagus , 2014, World Journal of Surgery.

[13]  Sean M. O'Brien,et al.  Bedside Tool for Predicting the Risk of Postoperative Dialysis in Patients Undergoing Cardiac Surgery , 2006, Circulation.

[14]  Suchi Saria,et al.  Subtyping: What It is and Its Role in Precision Medicine , 2015, IEEE Intelligent Systems.

[15]  P. Pronovost,et al.  A targeted real-time early warning score (TREWScore) for septic shock , 2015, Science Translational Medicine.

[16]  Michael J. Rothman,et al.  Development and validation of a continuous measure of patient condition using the Electronic Medical Record , 2013, J. Biomed. Informatics.

[17]  Ella S. Franklin,et al.  Learning Data-Driven Patient Risk Stratification Models for Clostridium difficile , 2014, Open forum infectious diseases.

[18]  F. Orzan,et al.  Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. , 1987, The Annals of thoracic surgery.

[19]  L. Neumayer,et al.  Multivariable predictors of postoperative respiratory failure after general and vascular surgery: results from the patient safety in surgery study. , 2007, Journal of the American College of Surgeons.

[20]  Elizabeth H. Bradley,et al.  Identifying Patients at Increased Risk for Unplanned Readmission , 2013, Medical care.

[21]  Andy Liaw,et al.  Classification and Regression by randomForest , 2007 .

[22]  Y. Tabak,et al.  An Automated Model to Identify Heart Failure Patients at Risk for 30-Day Readmission or Death Using Electronic Medical Record Data , 2010, Medical care.

[23]  Suchi Saria,et al.  Clustering Longitudinal Clinical Marker Trajectories from Electronic Health Data: Applications to Phenotyping and Endotype Discovery , 2015, AAAI.

[24]  B. Dean,et al.  Review: Use of Electronic Medical Records for Health Outcomes Research , 2009, Medical care research and review : MCRR.

[25]  Andrea Montanari,et al.  A Low-Cost Method for Multiple Disease Prediction , 2015, AMIA.

[26]  M. Shapiro,et al.  Unplanned intensive care unit admission following trauma. , 2016, Journal of critical care.

[27]  Michael J Rothman,et al.  Measuring the modified early warning score and the Rothman Index: Advantages of utilizing the electronic medical record in an early warning system , 2013, Journal of hospital medicine.

[28]  D. Koller,et al.  Integration of Early Physiological Responses Predicts Later Illness Severity in Preterm Infants , 2010, Science Translational Medicine.

[29]  L. Kavoussi,et al.  Surgical Complications and Their Repercussions. , 2016, Journal of endourology.

[30]  H V Anderson,et al.  The American College of Cardiology-National Cardiovascular Data Registry™ (ACC-NCDR™): building a national clinical data repository , 2001 .

[31]  Tom Fawcett,et al.  An introduction to ROC analysis , 2006, Pattern Recognit. Lett..

[32]  Harlan M Krumholz,et al.  Statistical models and patient predictors of readmission for heart failure: a systematic review. , 2008, Archives of internal medicine.

[33]  Suchi Saria,et al.  Consensus Statement on Electronic Health Predictive Analytics: A Guiding Framework to Address Challenges , 2016, EGEMS.

[34]  Kourtney J. Davis,et al.  Using an electronic medical record (EMR) to conduct clinical trials: Salford Lung Study feasibility , 2015, BMC Medical Informatics and Decision Making.

[35]  Mark Woodward,et al.  Risk prediction in patients with heart failure: a systematic review and analysis. , 2014, JACC. Heart failure.

[36]  K. Davis,et al.  Using the Rothman index to predict early unplanned surgical intensive care unit readmissions , 2014, The journal of trauma and acute care surgery.