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Stretton B, Booth AEC, Satheakeerthy S, Howson S, Evans S, Kovoor J, Akram W, McNeil K, Hopkins A, Zeitz K, Leslie A, Psaltis P, Gupta A, Tan S, Teo M, Vanlint A, Chan WO, Zannettino A, O'Callaghan PG, Maddison J, Gluck S, Gilbert T, Bacchi S. Translational artificial intelligence-led optimization and realization of estimated discharge with a supportive weekend interprofessional flow team (TAILORED-SWIFT). Intern Emerg Med 2024; 19:1913-1919. [PMID: 38907756 DOI: 10.1007/s11739-024-03689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/17/2024] [Indexed: 06/24/2024]
Abstract
Weekend discharges occur less frequently than discharges on weekdays, contributing to hospital congestion. Artificial intelligence algorithms have previously been derived to predict which patients are nearing discharge based upon ward round notes. In this implementation study, such an artificial intelligence algorithm was coupled with a multidisciplinary discharge facilitation team on weekend shifts. This approach was implemented in a tertiary hospital, and then compared to a historical cohort from the same time the previous year. There were 3990 patients included in the study. There was a significant increase in the proportion of inpatients who received weekend discharges in the intervention group compared to the control group (median 18%, IQR 18-20%, vs median 14%, IQR 12% to 17%, P = 0.031). There was a corresponding higher absolute number of weekend discharges during the intervention period compared to the control period (P = 0.025). The studied intervention was associated with an increase in weekend discharges and economic analyses support this approach as being cost-effective. Further studies are required to examine the generalizability of this approach to other centers.
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Affiliation(s)
- Brandon Stretton
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Andrew E C Booth
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Shrirajh Satheakeerthy
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Sarah Howson
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Shaun Evans
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Joshua Kovoor
- University of Adelaide, Adelaide, SA, 5005, Australia
- Ballarat Base Hospital, Ballarat Vic, Australia
| | - Waqas Akram
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
| | - Keith McNeil
- Commission On Excellence and Innovation in Health, Adelaide, SA, 5000, Australia
| | | | - Kathryn Zeitz
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Alasdair Leslie
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Peter Psaltis
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Aashray Gupta
- Royal North Shore Hospital, St Leonard's, NSW, 2065, Australia
| | - Sheryn Tan
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Melissa Teo
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
| | - Andrew Vanlint
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
| | - Weng Onn Chan
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | | | - Patrick G O'Callaghan
- SA Health, Adelaide, SA, 5000, Australia
- Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - John Maddison
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
| | - Samuel Gluck
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Toby Gilbert
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia
- SA Health, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Stephen Bacchi
- Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.
- SA Health, Adelaide, SA, 5000, Australia.
- University of Adelaide, Adelaide, SA, 5005, Australia.
- Flinders University, Bedford Park, SA, 5042, Australia.
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Kovoor JG, Stretton B, Gupta AK, Bacchi S. The Rosetta System: Lessons for rural Australian health care from successful implementation of a hospital-wide natural language processing system in metropolitan South Australia. Aust J Rural Health 2024; 32:850-852. [PMID: 38888239 DOI: 10.1111/ajr.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- Joshua G Kovoor
- Ballarat Base Hospital, Ballarat, Victoria, Australia
- University of Melbourne, Ballarat, Victoria, Australia
- Deakin University, Ballarat, Victoria, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- University of Sydney, Sydney, New South Wales, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Ooi K. Using Artificial Intelligence in Patient Care-Some Considerations for Doctors and Medical Regulators. Asian Bioeth Rev 2024; 16:483-499. [PMID: 39022377 PMCID: PMC11250739 DOI: 10.1007/s41649-024-00291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
This paper discusses the key role medical regulators have in setting standards for doctors who use artificial intelligence (AI) in patient care. Given their mandate to protect public health and safety, it is incumbent on regulators to guide the profession on emerging and vexed areas of practice such as AI. However, formulating effective and robust guidance in a novel field is challenging particularly as regulators are navigating unfamiliar territory. As such, regulators themselves will need to understand what AI is and to grapple with its ethical and practical challenges when doctors use AI in their care of patients. This paper will also argue that effective regulation of AI extends beyond devising guidance for the profession. It includes keeping abreast of developments in AI-based technology and considering the implications for regulation and the practice of medicine. On that note, medical regulators should encourage the profession to evaluate how AI may exacerbate existing issues in medicine and create unintended consequences so that doctors (and patients) are realistic about AI's potential and pitfalls when it is used in health care delivery.
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Affiliation(s)
- Kanny Ooi
- Medical Council of New Zealand, Wellington, New Zealand
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Kovoor JG, Ittimani C, Godber H, Herath A, Ovenden M, Ovenden CD, Hewitt JN, Zaka A, Ittimani M, Marshall-Webb M, Gupta AK, Stretton B, Bacchi S. No shortcuts: False economy prevention during artificial intelligence implementation in rural Australian health care. Aust J Rural Health 2024; 32:408-410. [PMID: 38506496 DOI: 10.1111/ajr.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Joshua G Kovoor
- Ballarat Base Hospital, Ballarat, Victoria, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
| | | | - Harry Godber
- Spark Festival, Sydney, New South Wales, Australia
| | - Asith Herath
- Fox Sports Australia, Sydney, New South Wales, Australia
| | - Morgan Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Joseph N Hewitt
- Wagga Wagga Base Hospital, Wagga Wagga, New South Wales, Australia
| | - Ammar Zaka
- Health and Information, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Mana Ittimani
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Aashray K Gupta
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
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Kovoor JG, Bacchi S, Sharma P, Sharma S, Kumawat M, Stretton B, Gupta AK, Chan W, Abou-Hamden A, Maddern GJ. Artificial intelligence for surgical services in Australia and New Zealand: opportunities, challenges and recommendations. Med J Aust 2024; 220:234-237. [PMID: 38321813 DOI: 10.5694/mja2.52225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA
- Ballarat Base Hospital, Ballarat, VIC
| | | | | | | | | | | | | | - WengOnn Chan
- University of Adelaide, Adelaide, SA
- Queen Elizabeth Hospital, Adelaide, SA
| | - Amal Abou-Hamden
- University of Adelaide, Adelaide, SA
- Royal Adelaide Hospital, Adelaide, SA
| | - Guy J Maddern
- University of Adelaide, Adelaide, SA
- Queen Elizabeth Hospital, Adelaide, SA
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Jiang M, Kleinig O, Stanekova V, Stretton B, Gupta A, Bacchi S, Chan WO. Response to ChatGPT in surgical research and practice: a threat to academic integrity, authorship, and divergent thinking. ANZ J Surg 2024; 94:490-491. [PMID: 37743571 DOI: 10.1111/ans.18698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Melinda Jiang
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
| | - Oliver Kleinig
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
| | - Viera Stanekova
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
| | - Brandon Stretton
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
| | - Aashray Gupta
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
- Department of Cardiac Surgery, Gold Coast University Hospital, Queensland, Southport, Australia
| | - Stephen Bacchi
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, South Australia, Bedford Park, Australia
| | - Weng Onn Chan
- Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Adelaide, Australia
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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7
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Nann SD, Aujayeb N, Lu A, Nathin K, Lam L, Jiang M, Lee S, To MS, Ovenden CD, Hewitt JN, Goh R, Gluck S, Reid JL, Khurana S, Dobbins C, Hewett PJ, Padbury RT, Malycha J, Trochsler MI, Hugh TJ, Maddern GJ. Surgery's Rosetta Stone: Natural language processing to predict discharge and readmission after general surgery. Surgery 2023; 174:1309-1314. [PMID: 37778968 DOI: 10.1016/j.surg.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND This study aimed to examine the accuracy with which multiple natural language processing artificial intelligence models could predict discharge and readmissions after general surgery. METHODS Natural language processing models were derived and validated to predict discharge within the next 48 hours and 7 days and readmission within 30 days (based on daily ward round notes and discharge summaries, respectively) for general surgery inpatients at 2 South Australian hospitals. Natural language processing models included logistic regression, artificial neural networks, and Bidirectional Encoder Representations from Transformers. RESULTS For discharge prediction analyses, 14,690 admissions were included. For readmission prediction analyses, 12,457 patients were included. For prediction of discharge within 48 hours, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.86 and 0.86 for Bidirectional Encoder Representations from Transformers, 0.82 and 0.81 for logistic regression, and 0.82 and 0.81 for artificial neural networks. For prediction of discharge within 7 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.82 and 0.81 for Bidirectional Encoder Representations from Transformers, 0.75 and 0.72 for logistic regression, and 0.68 and 0.67 for artificial neural networks. For readmission prediction within 30 days, derivation and validation data set area under the receiver operator characteristic curves were, respectively: 0.55 and 0.59 for Bidirectional Encoder Representations from Transformers and 0.77 and 0.62 for logistic regression. CONCLUSION Modern natural language processing models, particularly Bidirectional Encoder Representations from Transformers, can effectively and accurately identify general surgery patients who will be discharged in the next 48 hours. However, these approaches are less capable of identifying general surgery patients who will be discharged within the next 7 days or who will experience readmission within 30 days of discharge.
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Affiliation(s)
- Joshua G Kovoor
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Royal Australasian College of Surgeons, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia. https://twitter.com/josh.kovoor
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia; Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brandon Stretton
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia; Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Nidhi Aujayeb
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Amy Lu
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Kayla Nathin
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Lydia Lam
- Health and Information, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Melinda Jiang
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Shane Lee
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Minh-Son To
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rudy Goh
- Health and Information, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Samuel Gluck
- University of Adelaide, Adelaide, South Australia, Australia
| | - Jessica L Reid
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sanjeev Khurana
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - James Malycha
- Royal Adelaide Hospital, Adelaide, South Australia, Australia; University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia; Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Guy J Maddern
- Department of Surgery, The Queen Elizabeth Hospital, The University of Adelaide, Adelaide, South Australia, Australia; Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
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Squires E, Bacchi S, Maddison J. We need to chat about artificial intelligence. Med J Aust 2023; 219:394. [PMID: 37644689 DOI: 10.5694/mja2.52081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
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Kovoor JG, Nann SD, Barot DD, Garg D, Hains L, Stretton B, Ovenden CD, Bacchi S, Chan E, Gupta AK, Hugh TJ. Prehabilitation for general surgery: a systematic review of randomized controlled trials. ANZ J Surg 2023; 93:2411-2425. [PMID: 37675939 DOI: 10.1111/ans.18684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/23/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. METHODS This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. RESULTS From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). CONCLUSIONS Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
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Affiliation(s)
- Joshua G Kovoor
- University of Sydney, Sydney, New South Wales, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dwarkesh D Barot
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Devanshu Garg
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erick Chan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aashray K Gupta
- University of Sydney, Sydney, New South Wales, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Malycha J, Reddi BA, Liew D, O'Callaghan PG, Beltrame JF, Zannettino AC, Jones KL, Horowitz M, Dobbins C, Hewett PJ, Trochsler MI, Maddern GJ. The Adelaide Score: An artificial intelligence measure of readiness for discharge after general surgery. ANZ J Surg 2023; 93:2119-2124. [PMID: 37264548 DOI: 10.1111/ans.18546] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This study aimed to examine the performance of machine learning algorithms for the prediction of discharge within 12 and 24 h to produce a measure of readiness for discharge after general surgery. METHODS Consecutive general surgery patients at two tertiary hospitals, over a 2-year period, were included. Observation and laboratory parameter data were stratified into training, testing and validation datasets. Random forest, XGBoost and logistic regression models were evaluated. Each ward round note time was taken as a different event. Primary outcome was classification accuracy of the algorithmic model able to predict discharge within the next 12 h on the validation data set. RESULTS 42 572 ward round note timings were included from 8826 general surgery patients. Discharge occurred within 12 h for 8800 times (20.7%), and within 24 h for 9885 (23.2%). For predicting discharge within 12 h, model classification accuracies for derivation and validation data sets were: 0.84 and 0.85 random forest, 0.84 and 0.83 XGBoost, 0.80 and 0.81 logistic regression. For predicting discharge within 24 h, model classification accuracies for derivation and validation data sets were: 0.83 and 0.84 random forest, 0.82 and 0.81 XGBoost, 0.78 and 0.79 logistic regression. Algorithms generated a continuous number between 0 and 1 (or 0 and 100), representing readiness for discharge after general surgery. CONCLUSIONS A derived artificial intelligence measure (the Adelaide Score) successfully predicts discharge within the next 12 and 24 h in general surgery patients. This may be useful for both treating teams and allied health staff within surgical systems.
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Affiliation(s)
- Joshua G Kovoor
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- Flinders University, Adelaide, South Australia, Australia
| | - James Malycha
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Benjamin A Reddi
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Danny Liew
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Patrick G O'Callaghan
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John F Beltrame
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Karen L Jones
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael Horowitz
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher Dobbins
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Peter J Hewett
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
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