Research based on big data: The good, the bad, and the ugly

Factors associated with safe and successful postoperative day 1 discharge after lung operations: a systematic review and meta-analysis

BACKGROUND

A shorter length of stay (LOS) is associated with fewer hospital-acquired adverse conditions and decreased utilization of hospital resources. While modern perioperative care protocols have enabled some ambitious surgical teams to achieve discharge as early as within postoperative day 1 (POD1), most other teams remain cautious about such an approach due to the perceived risk of missing postoperative complications and increased readmission rates. We aimed to identify factors that would help guide surgical teams aiming for safe and successful POD1 discharge after lung resection.

METHODS

We searched the PubMed, Embase, Scopus, Web of Science and CENTRAL databases for articles comparing perioperative characteristics in patients discharged within POD1 (DWPOD1) and after POD1 (DAPOD1) following lung resection. Meta-analysis was performed using a random-effects model.

RESULTS

We included eight retrospective cohort studies with a total of 216,887 patients, of which 22,250 (10.3%) patients were DWPOD1. Our meta-analysis showed that younger patients, those without cardiovascular and respiratory comorbidities, and those with better preoperative pulmonary function are more likely to qualify for DWPOD1. Certain operative factors, such as a minimally invasive approach, shorter operations, and sublobar resections, also favor DWPOD1. DWPOD1 appears to be safe, with comparable 30-day mortality and readmission rates, and significantly less postoperative morbidity than DAPOD1.

CONCLUSIONS

In select patients with a favorable preoperative profile, DWPOD1 after lung resection can be achieved successfully and without increased risk of adverse outcomes such as postoperative morbidity, mortality, or readmissions.

Regional Private Financing Risk Index Model Based on Private Financing Big Data

With the rapid development of China's economy in recent decades, and the decentralization of the country's economic regulation and legal support, private financing has developed rapidly due to its simple, flexible and unique advantages. Some SMEs can solve it to some extent through private financing. The company's own financing issues have also helped the local financial market's effectiveness. Based on the “Yantai Private Financing Interest Rate Index,” this paper constructs a private financial risk index model from three perspectives of interest rate risk, scale risk and credit risk, and conducts a case simulation analysis of the private financing risk index. The characteristic indicators of the early warning system are screened from the macro, micro and stability dimensions, and subjective and objective adjustment coefficients are set for each indicator from both subjective and objective perspectives. This article takes the Yantai Index as the representative of China's private financing interest rate index. Based on the term structure of Yantai's private lending rate, this paper studies its response to macroeconomic shocks and analyzes the information value it contains. And use the private financing interest rate index to build a financial risk monitoring model. Through the system transformation model, the article finds that there is a significant asymmetry in the response of private lending to macroeconomic shocks. When private lending rates are higher, inflation has a greater effect on interest rates; when private lending rates are lower, monetary policy has a stronger regulatory effect on private lending rates. In the data processing, the principal component analysis method and the Bayesian vector autoregressive model were established. Through the study of this article, it is concluded that the interest rate decreases with the increase of the term, and the risk comparison is performed for the 1-month period, 3-month period, June period, 1-year period, and more than 1-year. The risks in the previous period are greater, and the risks in the March and June periods are relatively small. This model can be used to calculate the comprehensive evaluation value and its fluctuation in the historical risk market and historical equilibrium market, so as to determine the risk range of the comprehensive evaluation value. Thus, the early warning system is verified to be feasible.

The identification of cases of major hemorrhage during hospitalization in patients with acute leukemia using routinely recorded healthcare data

INTRODUCTION

Electronic health care data offers the opportunity to study rare events, although detecting these events in large datasets remains difficult. We aimed to develop a model to identify leukemia patients with major hemorrhages within routinely recorded health records.

METHODS

The model was developed using routinely recorded health records of a cohort of leukemia patients admitted to an academic hospital in the Netherlands between June 2011 and December 2015. Major hemorrhage was assessed by chart review. The model comprised CT-brain, hemoglobin drop, and transfusion need within 24 hours for which the best discriminating cut off values were taken. External validation was performed within a cohort of two other academic hospitals.

RESULTS

The derivation cohort consisted of 255 patients, 10,638 hospitalization days, of which chart review was performed for 353 days. The incidence of major hemorrhage was 0.22 per 100 days in hospital. The model consisted of CT-brain (yes/no), hemoglobin drop of ≥0.8 g/dl and transfusion of ≥6 units. The C-statistic was 0.988 (CI 0.981-0.995). In the external validation cohort of 436 patients (19,188 days), the incidence of major hemorrhage was 0.46 per 100 hospitalization days and the C-statistic was 0.975 (CI 0.970-0.980). Presence of at least one indicator had a sensitivity of 100% (CI 95.8-100) and a specificity of 90.7% (CI 90.2-91.1). The number of days to screen to find one case decreased from 217.4 to 23.6.

INTERPRETATION

A model based on information on CT-brain, hemoglobin drop and need of transfusions can accurately identify cases of major hemorrhage within routinely recorded health records.

N2-IIIA non-small cell lung cancer: a plea for surgery!

Management of stage IIIA-N2 non-small cell lung cancer is still matter of ongoing controversy. The debate is flawed by the heterogeneity of this group of patients, lack of strong evidence from controlled trials, diverging treatment strategies, and hesitating estimation of prognosis. Surgery is credited a survival advantage in a trimodality setting. For many teams, N2 is by principle managed with induction chemotherapy, followed by surgery if the patient is down-staged. However, surgery remains a suitable option even in case of persistent N2. On the other hand, outcomes are comparable, regardless whether chemotherapy has been given as induction or adjuvant treatment. Hence, upfront surgery without invasive staging, followed by adjuvant therapies, appears reasonable in resectable single station N2 disease, simplifying patient care and reducing cost. We expect that molecular biomarkers will improve estimation of prognosis and patient selection in the future.

Time series analysis of physiologic left ventricular reconstruction in ischemic cardiomyopathy

OBJECTIVE

The history of left ventricular reconstruction has demonstrated that the full spectrum of recoverable physiologic parameters is essential for a good functional result. We report the long-term outcome of a new surgical technique that arranges myocardial fibers in a near-normal disposition, also recovering left ventricular twisting.

METHODS

Between May 2006 and October 2013, 29 consecutive patients with previous anterior myocardial infarction and heart failure symptoms underwent physiologic left ventricular reconstruction surgery and coronary revascularization. Patients were examined by means of standard echocardiography and 2-dimensional speckle tracking at 8 time steps until 7 years after surgery. Ten geometric and functional parameters were evaluated at each step and analyzed by the linear mixed model test.

RESULTS

Hospital mortality was 0%. The mean percentage of indexed end-diastolic and end-systolic volume reduction was 45.7% and 50.9%, respectively. Ejection fraction and all of the volumes were significantly different in the postoperative period with a steady correction during time. Diastolic parameters were not worsened by surgical reconstruction. Ejection fraction and deceleration time showed a significant improvement during time. Left ventricular torsion increased immediately after the surgical correction from 2.8 ± 4.4 degrees to 8.7 ± 3.9 degrees (P = .02) and was still present 4 years after surgery.

CONCLUSIONS

Surgical conduction of ventricular reconstruction should be standardized to achieve the full spectrum of recoverable physiologic parameters. The renewal of ventricular torsion should be pursued as an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical level in the Frank-Starling relationship and pressure-volume loop.