Predicting post-discharge complications in cardiothoracic surgery: A clinical decision support system to optimize remote patient monitoring resources.

Autor: Santos R; Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal; Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Physics Department, NOVA School of Science and Technology, 2829-516 Caparica, Portugal. Electronic address: ricardo.santos@fraunhofer.pt., Ribeiro B; Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal., Sousa I; Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal., Santos J; Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Rua de Santa Marta, 50, 1169-023 Lisboa, Portugal., Guede-Fernández F; Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Physics Department, NOVA School of Science and Technology, 2829-516 Caparica, Portugal; Value for Health CoLAB, Av. Fontes Pereira de Melo, 15, 2°D, 1050-115 Lisboa, Portugal., Dias P; Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Value for Health CoLAB, Av. Fontes Pereira de Melo, 15, 2°D, 1050-115 Lisboa, Portugal., Carreiro AV; Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal., Gamboa H; Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal; Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UNL), Physics Department, NOVA School of Science and Technology, 2829-516 Caparica, Portugal., Coelho P; Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Rua de Santa Marta, 50, 1169-023 Lisboa, Portugal., Fragata J; Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Rua de Santa Marta, 50, 1169-023 Lisboa, Portugal., Londral A; Comprehensive Health Research Center, NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056 Lisboa, Portugal; Value for Health CoLAB, Av. Fontes Pereira de Melo, 15, 2°D, 1050-115 Lisboa, Portugal.
Jazyk: angličtina
Zdroj: International journal of medical informatics [Int J Med Inform] 2024 Feb; Vol. 182, pp. 105307. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1016/j.ijmedinf.2023.105307
Abstrakt: Cardiac surgery patients are highly prone to severe complications post-discharge. Close follow-up through remote patient monitoring can help detect adverse outcomes earlier or prevent them, closing the gap between hospital and home care. However, equipment is limited due to economic and human resource constraints. This issue raises the need for efficient risk estimation to provide clinicians with insights into the potential benefit of remote monitoring for each patient. Standard models, such as the EuroSCORE, predict the mortality risk before the surgery. While these are used and validated in real settings, the models lack information collected during or following the surgery, determinant to predict adverse outcomes occurring further in the future. This paper proposes a Clinical Decision Support System based on Machine Learning to estimate the risk of severe complications within 90 days following cardiothoracic surgery discharge, an innovative objective underexplored in the literature. Health records from a cardiothoracic surgery department regarding 5 045 patients (60.8% male) collected throughout ten years were used to train predictive models. Clinicians' insights contributed to improving data preparation and extending traditional pipeline optimization techniques, addressing medical Artificial Intelligence requirements. Two separate test sets were used to evaluate the generalizability, one derived from a patient-grouped 70/30 split and another including all surgeries from the last available year. The achieved Area Under the Receiver Operating Characteristic curve on these test sets was 69.5% and 65.3%, respectively. Also, additional testing was implemented to simulate a real-world use case considering the weekly distribution of remote patient monitoring resources post-discharge. Compared to the random resource allocation, the selection of patients with respect to the outputs of the proposed model was proven beneficial, as it led to a higher number of high-risk patients receiving remote monitoring equipment.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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