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Cho SY, Kim Z, Chung DR, Cho BH, Chung MJ, Kim JH, Jeong J. Development of machine learning models for the surveillance of colon surgical site infections. J Hosp Infect 2024; 146:224-231. [PMID: 37094715 DOI: 10.1016/j.jhin.2023.03.025] [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: 11/10/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Conventional surgical site infection (SSI) surveillance is labour-intensive. We aimed to develop machine learning (ML) models for the surveillance of SSIs for colon surgery and to assess whether the ML could improve surveillance process efficiency. METHODS This study included cases who underwent colon surgery at a tertiary center between 2013 and 2014. Logistic regression and four ML algorithms including random forest (RF), gradient boosting (GB), and neural networks (NNs) with or without recursive feature elimination (RFE) were first trained on the entire cohort, and then re-trained on cases selected based on a previous rule-based algorithm. We assessed model performance based on the area under the curve (AUC), sensitivity, and positive predictive value (PPV). The estimated proportion of reduction in workload for chart review based on the ML models was evaluated and compared with the conventional method. RESULTS At a sensitivity of 95%, the NN with RFE using 29 variables had the best performance with an AUC of 0.963 and PPV of 21.1%. When combining both the rule-based algorithm and ML algorithms, the NN with RFE using 19 variables had a higher PPV (28.9%) than with the ML algorithm alone, which could decrease the number of cases requiring chart review by 83.9% compared with the conventional method. CONCLUSION We demonstrated that ML can improve the efficiency of SSI surveillance for colon surgery by decreasing the burden of chart review while providing high sensitivity. In particular, the hybrid approach of ML with a rule-based algorithm showed the best performance in terms of PPV.
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Affiliation(s)
- S Y Cho
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Z Kim
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - D R Chung
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - B H Cho
- Department of Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea; Institute of Biomedical Informatics, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - M J Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Biomedical Science, Korea University College of Medicine, Seoul, Republic of Korea
| | - J Jeong
- Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
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Chung IY, Hur H, Lee J, Lee JW, Youn HJ, Han K, Kim NW, Jung SY, Kim Z, Kim KS, Lee MH, Han SH, Jung SH. Abstract P1-12-02: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Chung IY, Hur H, Lee J, Lee JW, Youn HJ, Han K, Kim NW, Jung S-Y, Kim Z, Kim KS, Lee MH, Han S-H, Jung SH. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-02.
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Affiliation(s)
- IY Chung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - H Hur
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - J Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - JW Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - HJ Youn
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - K Han
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - NW Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - S-Y Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Z Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - KS Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - MH Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - S-H Han
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
| | - SH Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea; Chonbuk National University Hospital, Jeonju, Republic of Korea; College of Medicine, Catholic University of Korea, Seoul, Republic of Korea; Breast Cancer Center, National Cancer Center, Goyang, Republic of Korea; Soonchunhyang University College of Medicine, Bucheon, Republic of Korea; Dongkang Medical Center, Ulsan, Republic of Korea; Ajou University, School of Medicine, Suwon, Republic of Korea
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Kim Z, Kang SG, Lee J, Kim SY, Lim CW, Lee MH. P2-16-14: Skin Sparing Mastectomy and Immediate Latissimus Dorsi Flap Reconstruction: Patient Reported Outcome and Factors Affecting the Highest Patient Satisfaction. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-16-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Skin sparing mastectomy (SSM) and immediate breast reconstruction (IBR) with latissimus dorsi (LD) flap is a tailored surgical procedure for breast cancer patients. In this study the oncologic safety, morbidities, and aesthetic results of SSM and LD IBR, as regards to patient satisfaction, were assessed.
Material and Methods: Between March 2000 and February 2011, single surgeon performed SSM and IBR for 145 patients. Eighty-five patients completed the patient satisfaction survey, and 65 patients with SSM and LD IBR were included. The patients were divided into 2 groups according to their degree of satisfaction, and a stratified analysis was performed.
Results: The mean age of the patients was 48.4 years (range, 21–74), and the pathologic results were infiltrating ductal carcinoma (n=48, 73.8%), ductal carcinoma in situ (n=15, 23.1%), and others (n=2, 3.1%). After a mean follow-up of 34 months (range, 1.6−89.9) no local recurrence occurred, and there were no skin necrosis or LD flap loss. Donor site morbidities were seroma (n=8, 12.3%), scarring (n=8, 12.3%), and back pain (n=6, 9.2%).
Fifty patients (76.9%) were satisfied with their surgical outcomes, and 40% reported their degree of satisfaction as excellent. Breast symmetry (P<0.001), nipple cosmesis (P<0.001), surgeon assessment (P<0.001), observer assessment (P<0.001), and visual difference of bilateral breasts (P=0.021) were factors that affected the highest patient satisfaction.
Conclusion: The present study demonstrated that our SSM and LD IBR was oncologically safe, and was associated with low morbidity rates. LD flap per se, without a prosthetic implant, could sufficiently produce a high level of patient satisfaction. Accurate surgical techniuqes and careful consideration for breast symmetry and nipple cosmesis would be the key to meet the patient's expectations and enhanced quality of life.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-14.
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Affiliation(s)
- Z Kim
- 1Soonchunhyang University Hospital, Seoul, Korea
| | - S-G Kang
- 1Soonchunhyang University Hospital, Seoul, Korea
| | - J Lee
- 1Soonchunhyang University Hospital, Seoul, Korea
| | - SY Kim
- 1Soonchunhyang University Hospital, Seoul, Korea
| | - CW Lim
- 1Soonchunhyang University Hospital, Seoul, Korea
| | - MH Lee
- 1Soonchunhyang University Hospital, Seoul, Korea
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