Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children's surgery
| Autor: | Nanhua Zhang, Lei Liu, J. 'Nick' Pratap, Yizhao Ni |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Quality management 020205 medical informatics Health Informatics 02 engineering and technology Logistic regression Machine learning computer.software_genre Machine Learning 03 medical and health sciences 0302 clinical medicine Contextual design Pediatric surgery Health care 0202 electrical engineering electronic engineering information engineering medicine Data Mining Electronic Health Records Humans Generalizability theory 030212 general & internal medicine Child health care economics and organizations Receiver operating characteristic Conceptualization business.industry Surgery Logistic Models ROC Curve General Surgery Artificial intelligence business computer |
| Zdroj: | International journal of medical informatics. 129 |
| ISSN: | 1872-8243 |
| Popis: | Background Last-minute surgery cancellation represents a major wastage of resources and can cause significant inconvenience to patients. Our objectives in this study were: 1) To develop predictive models of last-minute surgery cancellation, utilizing machine learning technologies, from patient-specific and contextual data from two distinct pediatric surgical sites of a single institution; and 2) to identify specific key predictors that impact children’s risk of day-of-surgery cancellation. Methods and findings We extracted five-year datasets (2012–2017) from the Electronic Health Record at Cincinnati Children’s Hospital Medical Center. By leveraging patient-specific information and contextual data, machine learning classifiers were developed to predict all patient-related cancellations and the most frequent four cancellation causes individually (patient illness, “no show,” NPO violation and refusal to undergo surgery by either patient or family). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) using ten-fold cross-validation. The best performance for predicting all-cause surgery cancellation was generated by gradient-boosted logistic regression models, with AUC 0.781 (95% CI: [0.764,0.797]) and 0.740 (95% CI: [0.726,0.771]) for the two campuses. Of the four most frequent individual causes of cancellation, “no show” and NPO violation were predicted better than patient illness or patient/family refusal. Models showed good cross-campus generalizability (AUC: 0.725/0.735, when training on one site and testing on the other). To synthesize a human-oriented conceptualization of pediatric surgery cancellation, an iterative step-forward approach was applied to identify key predictors which may inform the design of future preventive interventions. Conclusions Our study demonstrated the capacity of machine learning models for predicting pediatric patients at risk of last-minute surgery cancellation and providing useful insight into root causes of cancellation. The approach offers the promise of targeted interventions to significantly decrease both healthcare costs and also families’ negative experiences. |
| Databáze: | OpenAIRE |
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