title: Detection of clinically important colorectal surgical site infection using Bayesian network.
abstract: Despite extensive efforts to monitor and prevent surgical site infections (SSIs), real-time surveillance of clinical practice has been sparse and expensive or nonexistent. However, natural language processing (NLP) and machine learning (i.e., Bayesian network analysis) may provide the methodology necessary to approach this issue in a new way. We investigated the ability to identify SSIs after colorectal surgery (CRS) through an automated detection system using a Bayesian network.
  
  
  
  Patients who underwent CRS from 2010 to 2012 and were captured in our institutional American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) comprised our cohort. A Bayesian network was applied to detect SSIs using risk factors from ACS-NSQIP data and keywords extracted from clinical notes by NLP. Two surgeons provided expertise informing the Bayesian network to identify clinically meaningful SSIs (CM-SSIs) occurring within 30 d after surgery.
  
  
  
  We used data from 751 CRS cases experiencing 67 (8.9%) SSIs and 78 (10.4%) CM-SSIs. Our Bayesian network detected ACS-NSQIP-captured SSIs with a receiver operating characteristic area under the curve of 0.827, but this value increased to 0.892 when using surgeon-identified CM-SSIs.
  
  
  
  A Bayesian network coupled with NLP has the potential to be used in real-time SSI surveillance. Moreover, surgeons identified CM-SSI not captured under current NSQIP definitions. Future efforts to expand CM-SSI identification may lead to improved and potentially automated approaches to survey for postoperative SSI in clinical practice.
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sunghwan
authors.initials: S
authors.lastname: Sohn
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jasim Y
authors.initials: JY
authors.lastname: Alabbad
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Electronic address: liu.hongfang@mayo.edu.
authors.forename: Hongfang
authors.initials: H
authors.lastname: Liu
mesh_terms: D001499:Bayes Theorem; D003107:Colorectal Surgery; D006801:Humans; D008485:Medical Audit / Q000379:methods*; D009323:Natural Language Processing; D058996:Quality Improvement; D012189:Retrospective Studies; D013530:Surgical Wound Infection
keywords: Bayesian network; Colorectal surgery; Natural language processing; Surgical site infection