Feng Zheng

Lasith Adhikari, Tezcan Ozrazgat-Baslanti, Paul Thottakkara et al.

Acute kidney injury (AKI) is a common and serious complication after a surgery which is associated with morbidity and mortality. The majority of existing perioperative AKI risk score prediction models are limited in their generalizability and do not fully utilize the physiological intraoperative time-series data. Thus, there is a need for intelligent, accurate, and robust systems, able to leverage information from large-scale data to predict patient's risk of developing postoperative AKI. A retrospective single-center cohort of 2,911 adult patients who underwent surgery at the University of Florida Health has been used for this study. We used machine learning and statistical analysis techniques to develop perioperative models to predict the risk of AKI (risk during the first 3 days, 7 days, and until the discharge day) before and after the surgery. In particular, we examined the improvement in risk prediction by incorporating three intraoperative physiologic time series data, i.e., mean arterial blood pressure, minimum alveolar concentration, and heart rate. For an individual patient, the preoperative model produces a probabilistic AKI risk score, which will be enriched by integrating intraoperative statistical features through a machine learning stacking approach inside a random forest classifier. We compared the performance of our model based on the area under the receiver operating characteristics curve (AUROC), accuracy and net reclassification improvement (NRI). The predictive performance of the proposed model is better than the preoperative data only model. For AKI-7day outcome: The AUC was 0.86 (accuracy was 0.78) in the proposed model, while the preoperative AUC was 0.84 (accuracy 0.76). Furthermore, with the integration of intraoperative features, we were able to classify patients who were misclassified in the preoperative model.

Meghan Brennan, Sahil Puri, Tezcan Ozrazgat-Baslanti et al.

Background: Major postoperative complications are associated with increased short and long-term mortality, increased healthcare cost, and adverse long-term consequences. The large amount of data contained in the electronic health record (EHR) creates barriers for physicians to recognize patients most at risk. We hypothesize, if presented in an optimal format, information from data-driven predictive risk algorithms for postoperative complications can improve physician risk assessment. Methods: Prospective, non-randomized, interventional pilot study of twenty perioperative physicians at a quarterly academic medical center. Using 150 clinical cases we compared physicians' risk assessment before and after interaction with MySurgeryRisk, a validated machine-learning algorithm predicting preoperative risk for six major postoperative complications using EHR data. Results: The area under the curve (AUC) of MySurgeryRisk algorithm ranged between 0.73 and 0.85 and was significantly higher than physicians' risk assessments (AUC between 0.47 and 0.69) for all postoperative complications except cardiovascular complications. The AUC for repeated physician's risk assessment improved by 2% to 5% for all complications with the exception of thirty-day mortality. Physicians' risk assessment for acute kidney injury and intensive care unit admission longer than 48 hours significantly improved after knowledge exchange, resulting in net reclassification improvement of 12.4% and 16%, respectively. Conclusions: The validated MySurgeryRisk algorithm predicted postoperative complications with equal or higher accuracy than pilot cohort of physicians using available clinical preoperative data. The interaction with algorithm significantly improved physicians' risk assessment.

Zheng Feng, Rajendra Rana Bhat, Xiaoyong Yuan et al.

Surgery risk assessment is an effective tool for physicians to manage the treatment of patients, but most current research projects fall short in providing a comprehensive platform to evaluate the patients' surgery risk in terms of different complications. The recent evolution of big data analysis techniques makes it possible to develop a real-time platform to dynamically analyze the surgery risk from large-scale patients information. In this paper, we propose the Intelligent Perioperative System (IPS), a real-time system that assesses the risk of postoperative complications (PC) and dynamically interacts with physicians to improve the predictive results. In order to process large volume patients data in real-time, we design the system by integrating several big data computing and storage frameworks with the high through-output streaming data processing components. We also implement a system prototype along with the visualization results to show the feasibility of system design.