Article of the Month – November 2023

Published by Daniel at November 29, 2023

Performance of a Machine Learning Algorithm Using Electronic Health Record Data to Predict Postoperative Complications and Report on a Mobile Platform

JAMA Network Open – Health Informatics – May 16 2022

Yuanfang Ren^{1 2}, Tyler J Loftus^{1 3}, Shounak Datta^{1 2}, Matthew M Ruppert^{1 2}, Ziyuan Guan^{1 2}et al

Importance

Predicting postoperative complications has the potential to inform shared decisions regarding the appropriateness of surgical procedures, targeted risk-reduction strategies, and postoperative resource use. Realizing these advantages requires that accurate real-time predictions be integrated with clinical and digital workflows; artificial intelligence predictive analytic platforms using automated electronic health record (EHR) data inputs offer an intriguing possibility for achieving this, but there is a lack of high-level evidence from prospective studies supporting their use.

Objectives

To examine whether the MySurgeryRisk artificial intelligence system has stable predictive performance between development and prospective validation phases and whether it is feasible to provide automated outputs directly to surgeons’ mobile devices.

Design, Setting and Participants

In this prognostic study, the platform used automated EHR data inputs and machine learning algorithms to predict postoperative complications and provide predictions to surgeons, previously through a web portal and currently through a mobile device application. All patients 18 years or older who were admitted for any type of inpatient surgical procedure (74 417 total procedures involving 58 236 patients) between June 1, 2014, and September 20, 2020, were included. Models were developed using retrospective data from 52 117 inpatient surgical procedures performed between June 1, 2014, and November 27, 2018. Validation was performed using data from 22 300 inpatient surgical procedures collected prospectively from November 28, 2018, to September 20, 2020.

Main outcomes

Algorithms for generalized additive models and random forest models were developed and validated using real-time EHR data. Model predictive performance was evaluated primarily using area under the receiver operating characteristic curve (AUROC) values.

Results

Among 58 236 total adult patients who received 74 417 major inpatient surgical procedures, the mean (S.D.) age was 57 (17) years; 29 226 patients (50.2%) were male. Results reported in this article focus primarily on the validation cohort. The validation cohort included 22 300 inpatient surgical procedures involving 19 132 patients (mean [S.D.] age, 58 [17] years; 9672 [50.6%] male). A total of 2765 patients (14.5%) were Black or African American, 14 777 (77.2%) were White, 1235 (6.5%) were of other races (including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, and multiracial), and 355 (1.9%) were of unknown race because of missing data; 979 patients (5.1%) were Hispanic, 17 663 (92.3%) were non-Hispanic, and 490 (2.6%) were of unknown ethnicity because of missing data. A greater number of input features was associated with stable or improved model performance. For example, the random forest model trained with 135 input features had the highest AUROC values for predicting acute kidney injury (0.82; 95% CI, 0.82-0.83); cardiovascular complications (0.81; 95% CI, 0.81-0.82); neurological complications, including delirium (0.87; 95% CI, 0.87-0.88); prolonged intensive care unit stay (0.89; 95% CI, 0.88-0.89); prolonged mechanical ventilation (0.91; 95% CI, 0.90-0.91); sepsis (0.86; 95% CI, 0.85-0.87); venous thromboembolism (0.82; 95% CI, 0.81-0.83); wound complications (0.78; 95% CI, 0.78-0.79); 30-day mortality (0.84; 95% CI, 0.82-0.86); and 90-day mortality (0.84; 95% CI, 0.82-0.85), with accuracy similar to surgeons’ predictions. Compared with the original web portal, the mobile device application allowed efficient fingerprint login access and loaded data approximately 10 times faster. The application output displayed patient information, risk of postoperative complications, top 3 risk factors for each complication, and patterns of complications for individual surgeons compared with their colleagues.

Conclusions

In this study, automated real-time predictions of postoperative complications with mobile device outputs performed well in clinical settings with prospective validation, matching surgeons’ predictive accuracy.

Relevance to Healthcare Field

With more than 15 million surgical procedures completed in the U.S. every year, approximately 32% of postoperative complications emerge, prolonging the hospital stay and increasing cost and mortality. This study proposes using the MySurgeryRisk platform, which integrates the data collected in the EHR from each patient to anticipate postoperative complications and mortality risk and send the results to the surgeons’ devices. With the application of this platform, not only will it bring benefits for the patients, but also for the hospitals. Surgeons will know what could be done before surgery to decrease the risks or will be prepared to give immediate, timesaving treatment if the complication develops. It will also be cost-effective through avoidance of further unnecessary treatment or procedures to diagnose the possible complication. By being time-saving and cost-effective, the mortality risk will decrease.