Decision Tree Development to Analyze Influential Factors Effecting on PatientsLength of Stay at Intensive Care Unit After Cardiac Surgery

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 414

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شناسه ملی سند علمی:

NCMIMED02_093

تاریخ نمایه سازی: 1 دی 1397

چکیده مقاله:

Background: The patients undergoing cardiac operation are routinely sent to the intensive care unit (ICU) after the surgery. Due to this sections critical nature and in order to reduce health care costs, it is necessary to determine the features affecting the length of stay at ICU after cardiac surgery. This study aimed to investigate the most influential factors effecting on patients length of stay at ICU after cardiac surgery. Material and Methods: Firstly, a literature review conducted in four main databases including Web of Science (ISI), PubMed, SCOPUS, PROQUEST using defined search strategy. Having applied the inclusion/exclusion criteria, 15 relevant papers were found revealing 32 factors effecting on the outcome variable of length of stay at ICU after cardiac surgery. Secondly, related data for found variables were collected in three ICU of hospitals of Shiraz/Iran including Namazi, Shahid Faghihi, and Al-Zahra Heart Hospital within the second quarter of 2016 through a non-random convenience sampling method. Data of 311 operated patients collectedmanually prospectively from the form available in the patients’ files, including Perfusion Data Sheet and Anesthesia Record Sheet. Those data not recorded in the patients’ files were collected through interview with the patients. After data collection and preparation, C5 CART decision tree were developed through dividing the entire datasets into two sets randomly: a training set consisted of 70% of the data for model development, and a test set consisted of the remaining (30%) for model validation.Results: Among 32 variables cleared in literature review, finally 23 influential factors determined as important Features. For collected data, it was showed that the mean age and BMI of studied patients were 49.38 and 0.88% respectively. It achieved good discrimination power with AUC above 0.80. These variables came across the developed CART decision tree. There are as follow: age, Gender, Surgery type, hematocrit, Type of operation, Duration CPB, Clamp time, IVEF, Renal disease, Reoperation, Hypertension, OPCAB, CPB,sinus rhythm, Myocardia infraction, Mild valve pathology, NYHA, Creatinine, MIDCAB, HVS, hyper cholesterol, Preoperative infection, BMI.Conclusion: Our study emphasizes the utility of DT for exploring interactions between variables influencing on length of stay at ICU after cardiac surgery. Three main categories including demographic and individual characteristics (4 factors), surgical features (10 factors) and clinical features (18 factors) were defined. This study addressed more specialized factors including CLAMP TIME, cardiogenic shock, embolic history, left ventricular ejection volume, left ventricular dysfunction, coronary artery bypass through PUMP-OFFmethod, cardiopulmonary bypass and Heart valve surgery

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نویسندگان

Hamidreza Maharlou

MSc of Health Services Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran

Ramin Ravangard

Assistant Professor, Department of Health Services Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

Sharareh R Niakan Kalhori

Assistant Professor, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran

Shahrbanoo Shahbazi

Associate Professor, Department of Anesthesia, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran