Addressing racial disparities in surgical care with machine learning

Halamka, John; Bydon, Mohamad; Cerrato, Paul

doi:10.1038/s41746-022-00695-6

Cited by 10 publications

(6 citation statements)

References 33 publications

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“…These data are consistent with previous reports demonstrating inequitable care of Black/minority patients relative to other facets of CRC care, such as cancer screening, delayed surgical intervention, and receipt of guideline-compliant care. 35–39 The findings underscore the interplay between race/ethnicity and FI, demonstrating that minority patients residing in high FI regions may be disproportionately predisposed to greater social and health disparities relative to CRC care.…”

Section: Discussionmentioning

confidence: 90%

The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer

Azap,

Woldesenbet,

Akpunonu

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Food insecurity predisposes individuals to suboptimal nutrition, leading to chronic disease and poor outcomes. OBJECTIVE: We sought to assess the impact of county-level food insecurity on colorectal surgical outcomes. DESIGN: Retrospective cohort study. SETTING: SEER-Medicare database merged with county-level food insecurity obtained from the Feeding America: Mapping the Meal Gap report. Multiple logistic and Cox regression adjusted for patient-level covariates were implemented to assess outcomes. PATIENTS: Medicare beneficiaries diagnosed with colorectal cancer between 2010 and 2015. MAIN OUTCOME MEASURES: Surgical admission type (nonelective and elective admission), any complication, extended length-of-stay, discharge disposition (discharged to home and non-home discharge), 90-day readmission, 90-day mortality, and textbook outcome. Textbook outcome was defined as no extended length-of-stay, post-operative complications, 90-day readmission, and 90-day mortality. RESULTS: Among 72,354 colorectal cancer patients, 46,296 underwent resection. Within the surgical cohort, 9,091 (19.3%) were low, 27,716 (59.9%) were moderate, and 9,489 (20.5%) were high food insecurity. High food insecurity patients had greater odds of nonelective surgery (OR: 1.17, 95% CI: 1.09-1.26, p < 0.001), 90-day readmission (OR: 1.11, 95% CI: 1.04-1.19, p = 0.002), extended length-of-stay (OR: 1.32, 95% CI: 1.21-1.44, p < 0.001), and complications (OR: 1.11, 95% CI: 1.03-1.19, p = 0.002). High food insecurity patients also had decreased odds of home discharge (OR: 0.85, 95% CI: 0.79-0.91, p < 0.001) and textbook outcomes (OR: 0.81, 95%CI: 0.75-0.87, p < 0.001). High food insecurity minority patients had increased odds of complications (OR 1.59, 95% CI, 1.43-1.78) and extended length-of-stay (OR 1.89, 95% CI, 1.69-2.12) when compared with low food insecurity White individuals (all, p < 0.001). Notably, high food insecurity minority patients had 31% lower odds of textbook outcomes (OR: 0.69, 95% CI, 0.62-0.76, p < 0.001) compared with low food insecurity White patients (p < 0.001). LIMITATIONS: Limited to Medicare beneficiaries aged ≥65 years, hence may not be generalizable to younger populations or those with uninsurance/private insurance. CONCLUSIONS: County-level food insecurity was associated with suboptimal outcomes, demonstrating the importance of interventions to mitigate these inequities

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Section: Discussionmentioning

confidence: 90%

The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer

Azap,

Woldesenbet,

Akpunonu

et al. 2023

Diseases of the Colon &Amp; Rectum

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“…Without a critical assessment of digital technologies from an equity lens, these disparities may continue to be perpetuated. Halamka et al highlight the importance of using existing bias detection tools to detect irregularities in datasets and algorithms before deploying them in surgical practice 23 .…”

Section: Emerging Technologiesmentioning

confidence: 99%

The digital transformation of surgery

2023

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Rapid advances in digital technology and artificial intelligence in recent years have already begun to transform many industries, and are beginning to make headway into healthcare. There is tremendous potential for new digital technologies to improve the care of surgical patients. In this piece, we highlight work being done to advance surgical care using machine learning, computer vision, wearable devices, remote patient monitoring, and virtual and augmented reality. We describe ways these technologies can be used to improve the practice of surgery, and discuss opportunities and challenges to their widespread adoption and use in operating rooms and at the bedside.

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“…To avoid such traps, XAI should be designed to consider the specific needs of each target group (clinicians and developers). For developers, increasing model interpretability is important to assess the reliability of the model and eliminate bias 15,16 . For clinicians, clinical plausibility is most relevant to facilitate clinical sense-making of system outcomes 4,17,18 .…”

Section: Interviews and Focus Group With Clinicians And Developersmentioning

confidence: 99%

Solving the Explainable AI Conundrum: How to Bridge the Gap Between Clinicians Needs and Developers Goals

Bienefeld

Lüthy²,

Brodbeck

et al. 2022

Preprint

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Explainable AI (XAI) is considered the number one solution for overcoming implementation hurdles of AI/ML in clinical practice. However, it is still unclear how clinicians and developers interpret XAI (differently) and whether building such systems is achievable or even desirable. This longitudinal multi-method study queries (n=112) clinicians and developers as they co-developed the DCIP – an ML-based prediction system for Delayed Cerebral Ischemia. The resulting framework reveals that ambidexterity between exploration and exploitation can help bridge opposing goals and requirements to improve the design and implementation of AI/ML in healthcare.

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Addressing racial disparities in surgical care with machine learning

Cited by 10 publications

References 33 publications

The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer

The Association of Food Insecurity and Surgical Outcomes Among Patients Undergoing Surgery for Colorectal Cancer

The digital transformation of surgery

Solving the Explainable AI Conundrum: How to Bridge the Gap Between Clinicians Needs and Developers Goals

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