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Kovoor JG, Bacchi S, Gupta AK, Nann SD, Stretton B, Chong EHL, Hewitt JN, Bhanushali A, Nathin K, Aujayeb N, Lu A, Ovenden CD, John A, Reid JL, Gluck S, Liew D, Reddi BA, Hugh TJ, Dobbins C, Padbury RT, Hewett PJ, Trochsler MI, Maddern GJ. Sociocultural and Demographic Factors Predict Readmissions for General Surgery Patients. World J Surg 2023; 47:3124-3130. [PMID: 37775572 PMCID: PMC10694098 DOI: 10.1007/s00268-023-07177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Readmission is a poor outcome for both patients and healthcare systems. The association of certain sociocultural and demographic characteristics with likelihood of readmission is uncertain in general surgical patients. METHOD A multi-centre retrospective cohort study of consecutive unique individuals who survived to discharge during general surgical admissions was conducted. Sociocultural and demographic variables were evaluated alongside clinical parameters (considered both as raw values and their proportion of change in the 1-2 days prior to admission) for their association with 7 and 30 days readmission using logistic regression. RESULTS There were 12,701 individuals included, with 304 (2.4%) individuals readmitted within 7 days, and 921 (7.3%) readmitted within 30 days. When incorporating absolute values of clinical parameters in the model, age was the only variable significantly associated with 7-day readmission, and primary language and presence of religion were the only variables significantly associated with 30-day readmission. When incorporating change in clinical parameters between the 1-2 days prior to discharge, primary language and religion were predictive of 30-day readmission. When controlling for changes in clinical parameters, only higher comorbidity burden (represented by higher Charlson comorbidity index score) was associated with increased likelihood of 30-day readmission. CONCLUSIONS Sociocultural and demographic patient factors such as primary language, presence of religion, age, and comorbidity burden predict the likelihood of 7 and 30-day hospital readmission after general surgery. These findings support early implementation a postoperative care model that integrates all biopsychosocial domains across multiple disciplines of healthcare.
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Affiliation(s)
- Joshua G Kovoor
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Royal Australasian College of Surgeons, Adelaide, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
| | - Stephen Bacchi
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia
- Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Silas D Nann
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Brandon Stretton
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Esther H L Chong
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Joseph N Hewitt
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Ameya Bhanushali
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | | | | | - Amy Lu
- University of Adelaide, Adelaide, SA, Australia
| | - Christopher D Ovenden
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Athul John
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Jessica L Reid
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Samuel Gluck
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Danny Liew
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Benjamin A Reddi
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, NSW, Australia
- Royal North Shore Hospital, Sydney, NSW, Australia
| | - Christopher Dobbins
- Port Augusta Hospital, Port Augusta, SA, Australia
- Royal Adelaide Hospital, Adelaide, SA, Australia
- University of Adelaide, Adelaide, SA, Australia
| | - Robert T Padbury
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
- Flinders Medical Centre, Adelaide, SA, Australia
| | - Peter J Hewett
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
| | - Markus I Trochsler
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia
- Port Augusta Hospital, Port Augusta, SA, Australia
| | - Guy J Maddern
- Department of Surgery, The University of Adelaide, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, Australia.
- Royal Australasian College of Surgeons, Adelaide, SA, 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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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