Interactive decision support in hepatic surgery.
BACKGROUND
Hepatic surgery is characterized by complicated operations with a significant peri- and postoperative risk for the patient. We developed a web-based, high-granular research database for comprehensive documentation of all relevant variables to evaluate new surgical techniques.


METHODS
To integrate this research system into the clinical setting, we designed an interactive decision support component. The objective is to provide relevant information for the surgeon and the patient to assess preoperatively the risk of a specific surgical procedure. Based on five established predictors of patient outcomes, the risk assessment tool searches for similar cases in the database and aggregates the information to estimate the risk for an individual patient.


RESULTS
The physician can verify the analysis and exclude manually non-matching cases according to his expertise. The analysis is visualized by means of a Kaplan-Meier plot. To evaluate the decision support component we analyzed data on 165 patients diagnosed with hepatocellular carcinoma (period 1996-2000). The similarity search provides a two-peak distribution indicating there are groups of similar patients and singular cases which are quite different to the average. The results of the risk estimation are consistent with the observed survival data, but must be interpreted with caution because of the limited number of matching reference cases.


CONCLUSIONS
Critical issues for the decision support system are clinical integration, a transparent and reliable knowledge base and user feedback.
Dugas
Martin
M
Department of Medical Informatics, Biometrics and Epidemiology, University of Munich, D-81377 Munich, Germany. dug@ibe.med.uni-muenchen.de
Schauer
Rolf
R
Volk
Andreas
A
Rau
Horst
H
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D003626:Data Display / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000639:trends; D020000:Decision Support Systems, Clinical / Q000295:instrumentation; D003661:Decision Support Techniques; D006801:Humans; D020407:Internet; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008490:Medical Informatics / Q000639:trends; D011381:Programming Languages; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012984:Software; D014584:User-Computer Interface