Surgical data science: the new knowledge domain

Abstract Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care, with the goal of maximizing the quality and value of care. Whereas innovations in diagnostic and therapeutic technologies have driven past improvements in the quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytical techniques, and translation or integration of research findings into patient care. We foresee the emergence of surgical/interventional data science (SDS) as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model, and quantify the pathways or processes within the context of patient health states or outcomes and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data are pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care, including prevention, diagnosis, intervention, or postoperative recovery. The existing literature already provides preliminary results, suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from preoperative, intraoperative, and postoperative contexts, how it could support intraoperative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective assessments, automated virtual coaching, and robot-assisted active learning of surgical skill. However, the potential for transforming surgical care and training through SDS may only be realized through a cultural shift that not only institutionalizes technology to seamlessly capture data but also assimilates individuals with expertise in data science into clinical research teams. Furthermore, collaboration with industry partners from the inception of the discovery process promotes optimal design of data products as well as their efficient translation and commercialization. As surgery continues to evolve through advances in technology that enhance delivery of care, SDS represents a new knowledge domain to engineer surgical care of the future.

[1]  Guang-Zhong Yang,et al.  Soft-Tissue Motion Tracking and Structure Estimation for Robotic Assisted MIS Procedures , 2005, MICCAI.

[2]  Hamid Behnam,et al.  Characterizing Awake and Anesthetized States Using a Dimensionality Reduction Method , 2015, Journal of Medical Systems.

[3]  Russell H. Taylor,et al.  Rendering-based video-CT registration with physical constraints for image-guided endoscopic sinus surgery , 2015, Medical Imaging.

[4]  R. Flin,et al.  Non-technical skills for surgeons in the operating room: a review of the literature. , 2006, Surgery.

[5]  Lisa Lang,et al.  Improving the value of clinical research through the use of Common Data Elements , 2016, Clinical trials.

[6]  Peter Kazanzides,et al.  Virtual fixture assistance for needle passing and knot tying , 2016, 2016 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS).

[7]  Thomas Neumuth,et al.  Outcome quality assessment by surgical process compliance measures in laparoscopic surgery , 2015, Artif. Intell. Medicine.

[8]  Jorge Munoz-Gama,et al.  Process mining in healthcare: A literature review , 2016, J. Biomed. Informatics.

[9]  Catherine Yoon,et al.  Analysis of surgical errors in closed malpractice claims at 4 liability insurers. , 2006, Surgery.

[10]  Kevin Arce,et al.  The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Does Not Accurately Predict Risk of 30-Day Complications Among Patients Undergoing Microvascular Head and Neck Reconstruction. , 2016, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[11]  Omneya Attallah,et al.  An Artificial Neural Network Stratifies the Risks of Reintervention and Mortality after Endovascular Aneurysm Repair; a Retrospective Observational study , 2015, PloS one.

[12]  E. Lawson,et al.  Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. , 2013, JAMA surgery.

[13]  Vasant Dhar,et al.  Data science and prediction , 2012, CACM.

[14]  Amy Sheide,et al.  Standardizing Physiologic Assessment Data to Enable Big Data Analytics , 2017, Western journal of nursing research.

[15]  Mario Davidson,et al.  Teaching in the operating room: results of a national survey. , 2012, Journal of surgical education.

[16]  Pierre Jannin,et al.  Surgical process modelling: a review , 2014, International Journal of Computer Assisted Radiology and Surgery.

[17]  Thomas Neumuth,et al.  Modeling surgical processes: A four-level translational approach , 2011, Artif. Intell. Medicine.

[18]  Pierre Jannin,et al.  Automatic data-driven real-time segmentation and recognition of surgical workflow , 2016, International Journal of Computer Assisted Radiology and Surgery.

[19]  Danail Stoyanov,et al.  Vision‐based and marker‐less surgical tool detection and tracking: a review of the literature , 2017, Medical Image Anal..

[20]  Michael N. Mavros,et al.  Intraoperative Adverse Events in Abdominal Surgery: What Happens in the Operating Room Does Not Stay in the Operating Room , 2016, Annals of surgery.

[21]  Nassir Navab,et al.  Personalized, relevance-based Multimodal Robotic Imaging and augmented reality for Computer Assisted Interventions , 2016, Medical Image Anal..

[22]  J. Birkmeyer,et al.  Surgical skill and complication rates after bariatric surgery. , 2013, The New England journal of medicine.

[23]  Nicolai Schoch,et al.  Cognitive tools pipeline for assistance of mitral valve surgery , 2016, SPIE Medical Imaging.

[24]  Mirko Gilardino,et al.  Big Data and Machine Learning in Plastic Surgery: A New Frontier in Surgical Innovation , 2016, Plastic and reconstructive surgery.

[25]  Tej D. Azad,et al.  Size and distribution of the global volume of surgery in 2012 , 2016, Bulletin of the World Health Organization.

[26]  Alois Knoll,et al.  Selective automation and skill transfer in medical robotics: a demonstration on surgical knot‐tying , 2012, The international journal of medical robotics + computer assisted surgery : MRCAS.

[27]  Danail Stoyanov,et al.  Surgical robotics beyond enhanced dexterity instrumentation: a survey of machine learning techniques and their role in intelligent and autonomous surgical actions , 2016, International Journal of Computer Assisted Radiology and Surgery.

[28]  Russell H. Taylor,et al.  Vision-Based Proximity Detection in Retinal Surgery , 2012, IEEE Transactions on Biomedical Engineering.

[29]  Masaru Ishii,et al.  Objective Assessment of Surgical Technical Skill and Competency in the Operating Room. , 2017, Annual review of biomedical engineering.

[30]  Nicolai Schoch,et al.  Surgical Data Science: Enabling Next-Generation Surgery , 2017, ArXiv.

[31]  Douglas K Owens,et al.  Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 1: Series Overview and Methodology) , 2004 .

[32]  Masaru Ishii,et al.  Perspectives on Surgical Data Science , 2016, ArXiv.

[33]  Simon De Lusignan,et al.  Using ontologies to improve semantic interoperability in health data , 2015, BMJ Health & Care Informatics.

[34]  M. Makary,et al.  Prevalence and Data Transparency of National Clinical Registries in the United States , 2016, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[35]  Mahyar Taghizadeh Nouei,et al.  A comprehensive operating room information system using the Kinect sensors and RFID , 2015, Journal of Clinical Monitoring and Computing.

[36]  Rüdiger Dillmann,et al.  Bridging the gap between formal and experience-based knowledge for context-aware laparoscopy , 2016, International Journal of Computer Assisted Radiology and Surgery.

[37]  W. Weintraub,et al.  Predicting readmission risk following coronary artery bypass surgery at the time of admission. , 2017, Cardiovascular revascularization medicine : including molecular interventions.

[38]  Deverick J Anderson,et al.  Surgical Site Infections: An Update. , 2016, Infectious disease clinics of North America.

[39]  D. Puccinelli,et al.  Wireless sensor networks: applications and challenges of ubiquitous sensing , 2005, IEEE Circuits and Systems Magazine.

[40]  D. Wiegmann,et al.  Surgical coaching for individual performance improvement. , 2015, Annals of surgery.

[41]  Guang-Zhong Yang,et al.  A Probabilistic Framework for Tracking Deformable Soft Tissue in Minimally Invasive Surgery , 2007, MICCAI.

[42]  C. Ko,et al.  Development and Evaluation of the American College of Surgeons NSQIP Pediatric Surgical Risk Calculator. , 2016, Journal of the American College of Surgeons.

[43]  Philippe Cinquin,et al.  Image guided operating robot: a clinical application in stereotactic neurosurgery , 1992, Proceedings 1992 IEEE International Conference on Robotics and Automation.

[44]  C. Pugh,et al.  Error training: missing link in surgical education. , 2012, Surgery.

[45]  P. McCulloch,et al.  The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy , 2007, Surgical Endoscopy.

[46]  Fani Deligianni,et al.  Predictive Camera Tracking for Bronchoscope Simulation with CONDensation , 2005, MICCAI.

[47]  Matt Welsh,et al.  Sensor networks for medical care , 2005, SenSys '05.

[48]  Samuel L. Volchenboum,et al.  An Approach to Acquiring, Normalizing, and Managing EHR Data From a Clinical Data Repository for Studying Pressure Ulcer Outcomes , 2016, Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society.

[49]  P. Klepstad,et al.  Assessment of the time-dependent need for stay in a high dependency unit (HDU) after major surgery by using data from an anesthesia information management system , 2016, Journal of Clinical Monitoring and Computing.

[50]  Keno März,et al.  Toward knowledge-based liver surgery: holistic information processing for surgical decision support , 2015, International Journal of Computer Assisted Radiology and Surgery.

[51]  Ricky J. Sethi,et al.  Curriculum Guidelines for Undergraduate Programs in Data Science , 2017, 1801.06814.

[52]  Peter Donkor,et al.  Surgical care needs of low-resource populations: an estimate of the prevalence of surgically treatable conditions and avoidable deaths in 48 countries , 2015, The Lancet.

[53]  S. Woolf The meaning of translational research and why it matters. , 2008, JAMA.

[54]  Carolyn M Clancy,et al.  SCIP: making complications of surgery the exception rather than the rule. , 2008, AORN journal.

[55]  Byung-Ju Yi,et al.  Automation of Surgical Illumination System Using Robot and Ultrasonic Sensor , 2007, 2007 International Conference on Mechatronics and Automation.

[56]  Edith Burns,et al.  Postoperative 30-day Readmission: Time to Focus on What Happens Outside the Hospital , 2016, Annals of surgery.

[57]  T J Krizek,et al.  Surgical error: ethical issues of adverse events. , 2000, Archives of surgery.

[58]  R. Bell,et al.  Why Johnny cannot operate. , 2009, Surgery.

[59]  Xia He,et al.  Measuring hospital performance in congenital heart surgery: administrative versus clinical registry data. , 2015, The Annals of thoracic surgery.

[60]  Thomas Neumuth,et al.  Similarity metrics for surgical process models , 2012, Artif. Intell. Medicine.

[61]  Stuart R. Lipsitz,et al.  Patterns of Technical Error Among Surgical Malpractice Claims: An Analysis of Strategies to Prevent Injury to Surgical Patients , 2007, Annals of surgery.

[62]  Thomas Neumuth,et al.  Video-based detection of device interaction in the operating room , 2016, Biomedizinische Technik. Biomedical engineering.

[63]  Keno März,et al.  MITK-US: real-time ultrasound support within MITK , 2013, International Journal of Computer Assisted Radiology and Surgery.

[64]  Austin Reiter,et al.  Feature Classification for Tracking Articulated Surgical Tools , 2012, MICCAI.

[65]  Philippe Cinquin,et al.  Automatic Localization of Laparoscopic Instruments for the Visual Servoing of an Endoscopic Camera Holder , 2006, MICCAI.

[66]  Kayvan Najarian,et al.  A Signal Processing Approach for Detection of Hemodynamic Instability before Decompensation , 2016, PloS one.

[67]  Nassir Navab,et al.  Sensor substitution for video-based action recognition , 2016, 2016 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS).

[68]  Narges Ahmidi,et al.  Analysis of the Structure of Surgical Activity for a Suturing and Knot-Tying Task , 2016, PloS one.

[69]  Russell H. Taylor,et al.  Augmented reality during robot-assisted laparoscopic partial nephrectomy: toward real-time 3D-CT to stereoscopic video registration. , 2009, Urology.

[70]  Gregory D. Hager,et al.  A Dataset and Benchmarks for Segmentation and Recognition of Gestures in Robotic Surgery , 2017, IEEE Transactions on Biomedical Engineering.

[71]  Nabil Zemiti,et al.  Simplified adaptive path planning for percutaneous needle insertions , 2015, 2015 IEEE International Conference on Robotics and Automation (ICRA).

[72]  Harlan M. Krumholz,et al.  Data Acquisition, Curation, and Use for a Continuously Learning Health System. , 2016, JAMA.

[73]  C. Ko,et al.  Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. , 2013, Journal of the American College of Surgeons.

[74]  David M Studdert,et al.  Analysis of errors reported by surgeons at three teaching hospitals. , 2003, Surgery.

[75]  Hikaru Matsuda,et al.  In-patient step count predicts re-hospitalization after cardiac surgery. , 2015, Journal of cardiology.

[76]  Kenneth C. Wang,et al.  Technology standards in imaging: a practical overview. , 2014, Journal of the American College of Radiology : JACR.

[77]  Pablo Lamata,et al.  Methods and tools for objective assessment of psychomotor skills in laparoscopic surgery. , 2011, The Journal of surgical research.

[78]  Anand Malpani Automated Virtual Coach for Surgical Training , 2017 .

[79]  P. Fabri,et al.  Human error, not communication and systems, underlies surgical complications. , 2008, Surgery.

[80]  G. Loor,et al.  Process Improvement in Thoracic Donor Organ Procurement: Implementation of a Donor Assessment Checklist. , 2016, The Annals of thoracic surgery.

[81]  Ryan S. Decker,et al.  Supervised autonomous robotic soft tissue surgery , 2016, Science Translational Medicine.

[82]  Lucila Ohno-Machado Structuring text and standardizing data for clinical and population health applications , 2014, J. Am. Medical Informatics Assoc..

[83]  W. Barclay,et al.  Forgive and Remember: Managing Medical Failure , 1979 .

[84]  Bruno Arnaldi,et al.  Synthesis and Simulation of Surgical Process Models , 2016, MMVR.

[85]  William B. Lober,et al.  Prognostics of Surgical Site Infections using Dynamic Health Data , 2016, J. Biomed. Informatics.

[86]  R. Martindale,et al.  Do risk calculators accurately predict surgical site occurrences? , 2016, The Journal of surgical research.

[87]  Nassir Navab,et al.  Robust colonoscope tracking method for colon deformations utilizing coarse-to-fine correspondence findings , 2016, International Journal of Computer Assisted Radiology and Surgery.

[88]  Thomas Neumuth,et al.  Online time and resource management based on surgical workflow time series analysis , 2017, International Journal of Computer Assisted Radiology and Surgery.

[89]  Thomas Neumuth,et al.  Rule-based medical device adaptation for the digital operating room , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[90]  David C Aron,et al.  Adherence to surgical care improvement project measures and the association with postoperative infections. , 2010, JAMA.

[91]  Masaru Ishii,et al.  Automated objective surgical skill assessment in the operating room from unstructured tool motion in septoplasty , 2015, International Journal of Computer Assisted Radiology and Surgery.

[92]  Thomas Neumuth,et al.  Online recognition of surgical instruments by information fusion , 2012, International Journal of Computer Assisted Radiology and Surgery.

[93]  Tobias Ortmaier,et al.  Soft tissue motion tracking with application to tablet-based incision planning in laser surgery , 2016, International Journal of Computer Assisted Radiology and Surgery.

[94]  José Luis Rojo-Álvarez,et al.  Data-driven Temporal Prediction of Surgical Site Infection , 2015, AMIA.

[95]  Peter Kazanzides,et al.  Patient motion tracking in the presence of measurement errors , 2009, 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[96]  Carla M Pugh,et al.  A marker-less technique for measuring kinematics in the operating room. , 2016, Surgery.

[97]  Robert R Cima,et al.  Failure of Colorectal Surgical Site Infection Predictive Models Applied to an Independent Dataset: Do They Add Value or Just Confusion? , 2016, Journal of the American College of Surgeons.

[98]  Daniel T. Kettler,et al.  Stereo Display of 3D Ultrasound Images for Surgical Robot Guidance , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[99]  M Wagner,et al.  [Intelligent operating room suite : From passive medical devices to the self-thinking cognitive surgical assistant]. , 2016, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[100]  Nassir Navab,et al.  CRF-Based Model for Instrument Detection and Pose Estimation in Retinal Microsurgery , 2016, Comput. Math. Methods Medicine.

[101]  G. de Lissovoy,et al.  Surgical site infection: incidence and impact on hospital utilization and treatment costs. , 2009, American journal of infection control.

[102]  Graham A Colditz,et al.  Implementation science and its application to population health. , 2013, Annual review of public health.