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Article: Improving the accuracy of revised cardiac risk index with HbA1C: Hemoglobin ratio (HH ratio) - A retrospective cohort study.

Ke, Yuhe / Shannon, Nicholas Brian / Abdullah, Hairil Rizal

2023 Volume 10, Page(s) 998477

Abstract: Background: The current Lee's Revised cardiac risk index (RCRI) was created in 1999. Validation studies have found RCRI to be only moderately discriminant. The "Diabetes Mellitus on insulin" component of the score does not accurately reflect the ... ...

Abstract	Background: The current Lee's Revised cardiac risk index (RCRI) was created in 1999. Validation studies have found RCRI to be only moderately discriminant. The "Diabetes Mellitus on insulin" component of the score does not accurately reflect the severity of the disease. A previously studied HbA1C:Hemoglobin ratio shows an improved association with outcomes than individual components alone. Study design: A retrospective cohort study was performed in diabetic patients undergoing non-cardiac surgery. Ethics approval was obtained. The study compares the predictive value of RCRI and substitution of the "DM on insulin" component with HH ratio for 30- and 90-day mortality, and postoperative acute myocardial injury (AMI) and acute kidney injury (AKI). Results: A total of 20,099 adult patients were included in the final analysis. The incidence of 30- and 90-day mortality was at 4.2 and 6.5%, respectively. Substitution of HH ratio in RCRI resulted in 687 more patients being in the moderate to high-risk category. The substituted HH-RCRI score had better prediction for 30-day (AUC 0.66 vs. 0.69, Conclusion: Although currently not an universal practice, substitution of "DM on insulin" with HbA1C:Hemoglobin ratio in RCRI score improves the accuracy of the RCRI risk prediction model in diabetic patients going for non-cardiac surgery.
Language	English
Publishing date	2023-03-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.998477
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Article ; Online: Implications of Anemia in the Elderly Undergoing Surgery.

Sim, Yilin Eileen / Abdullah, Hairil Rizal

Clinics in geriatric medicine

2019 Volume 35, Issue 3, Page(s) 391–405

Abstract: Anemia in the elderly is common and is associated with exposure to blood transfusion and higher perioperative morbidity and mortality. These patients would benefit from early diagnosis and work-up of the cause of preoperative anemia systematically. This ... ...

Abstract	Anemia in the elderly is common and is associated with exposure to blood transfusion and higher perioperative morbidity and mortality. These patients would benefit from early diagnosis and work-up of the cause of preoperative anemia systematically. This can be done in preoperative anemia clinics as part of an overall patient blood management program. Iron-deficiency anemia is amenable to treatment with oral or intravenous iron. Intravenous iron leads to a more rapid hemoglobin response, and is devoid of gastrointestinal side effects. More data are needed to determine if preoperative correction of iron-deficiency anemia reduces the morbidity associated with anemia.
MeSH term(s)	Aged ; Anemia/complications ; Anemia/diagnosis ; Anemia/therapy ; Humans ; Middle Aged ; Patient Selection ; Preoperative Care
Language	English
Publishing date	2019-05-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1064151-8
ISSN	1879-8853 ; 0749-0690
ISSN (online)	1879-8853
ISSN	0749-0690
DOI	10.1016/j.cger.2019.04.001
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Article ; Online: Systematic review and meta-analysis of short-term and long-term smoking abstinence rates of intensive perioperative smoking cessation programs vs brief interventions for smoking cessation.

Tan, Monica / He, Yingke / Shi, Michelle / Lee, Ken Cheah Hooi / Abdullah, Hairil Rizal

Addictive behaviors

2023 Volume 148, Page(s) 107832

Abstract: Background: The perioperative period is an important "teachable moment" where smoking interventions may be particularly effective. We aim to explore the effectiveness of intensive perioperative smoking cessation programs not just on short term, but long ...

Abstract	Background: The perioperative period is an important "teachable moment" where smoking interventions may be particularly effective. We aim to explore the effectiveness of intensive perioperative smoking cessation programs not just on short term, but long term smoking abstinence as well. Methods: This is a systematic review and meta-analysis of randomized controlled trials published between 1 Jan 2007 and 15 May 2022. The studies include perioperative smoking cessation programs that were conducted either in the preoperative surgical clinic or anaesthesia clinic settings. Some programs included follow-up sessions in the postoperative phase. The primary outcomes were short-term and long-term smoking abstinence rates for patients who participated in intensive perioperative smoking cessation programs. Subgroup analyses were also conducted to compare the effects between patients undergoing surgery for smoking-induced and non-smoking induced illnesses. Results: In total, thirteen trials with a total of 2597 smokers undergoing elective surgery were included in the analysis. The pooled results show that patients who participated in intensive perioperative smoking cessation programs had a higher chance of abstinence in both short term (OR: 2.41, 95% CI [1.95 to 2.98], p < 0.001) and long term (OR: 1.64, CI [1.23 to 2.2], p < 0.001) periods postoperatively. This effect was seen regardless of whether patients underwent surgery for smoking-induced or non-smoking induced illnesses. Conclusions: Intensive peri-operative smoking interventions are more effective than brief interventions in achieving both short and long term abstinence. Hospitals should consider integrating structured intensive smoking interventions into perioperative care. Further studies examining the optimal timing and duration of such programs will be useful.
Language	English
Publishing date	2023-08-19
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	197618-7
ISSN	1873-6327 ; 0306-4603
ISSN (online)	1873-6327
ISSN	0306-4603
DOI	10.1016/j.addbeh.2023.107832
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Article ; Online: Prevalence and risk factors of preoperative malnutrition risk in older patients and its impact on surgical outcomes: a retrospective observational study.

Gn, Ying Mao / Abdullah, Hairil Rizal / Loke, Wayren / Sim, Yilin Eileen

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2021 Volume 68, Issue 5, Page(s) 622–632

Abstract: Purpose: Elderly patients are vulnerable to malnutrition and we have started systematic screening for preoperative malnutrition risk in our institution. This study aims to determine the prevalence and risk factors of preoperative malnutrition risk among ...

Title translation	Prévalence et facteurs de risque du risque de la malnutrition préopératoire chez les patients plus âgés et son impact sur les devenirs chirurgicaux : une étude observationnelle rétrospective.
Abstract	Purpose: Elderly patients are vulnerable to malnutrition and we have started systematic screening for preoperative malnutrition risk in our institution. This study aims to determine the prevalence and risk factors of preoperative malnutrition risk among elderly surgical patients, and its impact on surgical outcomes. Methods: In this retrospective cohort study of patients ≥ 65 yr old undergoing elective surgery, we recorded demographics, medications, preoperative effort tolerance, Malnutrition Universal Screening Tool (MUST) score, American Society of Anesthesiologists physical status (ASA), Charlson Comorbidity Index (CCI), and Edmonton Frailty Score (EFS). Postoperative complications based on the Clavien-Dindo (CD) classification and hospital length of stay (LOS) were also recorded. Results: Of the 1,033 patients studied, 123 (11.9%) were at risk of malnutrition (MUST ≥ 1), with 48 (4.6%) at high risk (MUST ≥ 2). Unadjusted predictors for high malnutrition risk included ASA ≥ III, higher EFS, higher CCI, polypharmacy (≥ ten medications), poor effort tolerance (metabolic equivalent of tasks < 3), malignancy, general surgery patients, and lower hemoglobin. These patients had higher odds of CD grade ≥ 1 complications compared with those without risk (adjusted odds ratio, 2.30; 95% confidence interval [CI], 1.11 to 4.78; P = 0.025) and 22% longer hospital LOS (adjusted incidence rate ratio,1.22; 95% CI, 1.00 to 1.49; P = 0.049) after multivariate adjustment for sex, severity of surgery, comorbidities, frailty, malignancy, and anemia. Conclusion: Preoperative malnutrition risk is prevalent among the elderly. Patients at high malnutrition risk have increased risk of postoperative complications and longer hospital LOS. Patients with high comorbidity burden and frailty should be screened for malnutrition so that nutritional optimization can be sought.
MeSH term(s)	Aged ; Frailty ; Humans ; Length of Stay ; Malnutrition/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prevalence ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-02-09
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/s12630-021-01933-3
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Article: Prehabilitation programs - a systematic review of the economic evidence.

Ke, Yuhe / Ng, Roderica Rui Ge / Elangovan, Shalini / Leong, Yun Hao / Goh, Zhao Han / Graves, Nicholas / Shannon, Nicholas B / Abdullah, Hairil Rizal

Frontiers in medicine

2023 Volume 10, Page(s) 1281843

Abstract: Introduction: Prehabilitation, which involves improving a patient's physical and psychological condition before surgery, has shown potential benefits but has yet to be extensively studied from an economic perspective. To address this gap, a systematic ... ...

Abstract	Introduction: Prehabilitation, which involves improving a patient's physical and psychological condition before surgery, has shown potential benefits but has yet to be extensively studied from an economic perspective. To address this gap, a systematic review was conducted to summarize existing economic evaluations of prehabilitation interventions. Methods: The PRISMA Protocols 2015 checklist was followed. Over 16,000 manuscripts were reviewed, and 99 reports on preoperative interventions and screening tests were identified, of which 12 studies were included in this analysis. The costs are expressed in Pounds (GBP, £) and adjusted for inflation to December 2022. Results: The studies were conducted in Western countries, focusing on specific surgical subspecialties. While the interventions and study designs varied, most studies demonstrated cost savings in the intervention group compared to the control group. Additionally, all cost-effectiveness analysis studies favored the intervention group. However, the review also identified several limitations. Many studies had a moderate or high risk of bias, and critical information such as time horizons and discount rates were often missing. Important components like heterogeneity, distributional effects, and uncertainty were frequently lacking as well. The misclassification of economic evaluation types highlighted a lack of knowledge among physicians in prehabilitation research. Conclusion: This review reveals a lack of robust evidence regarding the economics of prehabilitation programs for surgical patients. This suggests a need for further research with rigorous methods and accurate definitions.
Language	English
Publishing date	2023-12-01
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2023.1281843
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Article ; Online: The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry.

Abdullah, Hairil Rizal / Lim, Daniel Yan Zheng / Ke, Yuhe / Salim, Nur Nasyitah Mohamed / Lan, Xiang / Dong, Yizhi / Feng, Mengling

Korean journal of anesthesiology

2023 Volume 77, Issue 1, Page(s) 58–65

Abstract: Background: To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area ... ...

Abstract	Background: To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. Methods: Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. Results: As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. Conclusions: The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.
MeSH term(s)	Humans ; Middle Aged ; Data Warehousing ; Elective Surgical Procedures ; Patient Admission ; Anesthesia ; Registries
Language	English
Publishing date	2023-11-08
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2557340-8
ISSN	2005-7563 ; 2005-7563
ISSN (online)	2005-7563
ISSN	2005-7563
DOI	10.4097/kja.23580
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Book ; Online: Cluster trajectory of SOFA score in predicting mortality in sepsis

Ke, Yuhe / Tang, Matilda Swee Sun / Loh, Celestine Jia Ling / Abdullah, Hairil Rizal / Shannon, Nicholas Brian

2023

Abstract: Objective: Sepsis is a life-threatening condition. Sequential Organ Failure Assessment (SOFA) score is commonly used to assess organ dysfunction and predict ICU mortality, but it is taken as a static measurement and fails to capture dynamic changes. This ...

Abstract	Objective: Sepsis is a life-threatening condition. Sequential Organ Failure Assessment (SOFA) score is commonly used to assess organ dysfunction and predict ICU mortality, but it is taken as a static measurement and fails to capture dynamic changes. This study aims to investigate the relationship between dynamic changes in SOFA scores over the first 72 hours of ICU admission and patient outcomes. Design, setting, and participants: 3,253 patients in the Medical Information Mart for Intensive Care IV database who met the sepsis-3 criteria and were admitted from the emergency department with at least 72 hours of ICU admission and full-active resuscitation status were analysed. Group-based trajectory modelling with dynamic time warping and k-means clustering identified distinct trajectory patterns in dynamic SOFA scores. They were subsequently compared using Python. Main outcome measures: Outcomes including hospital and ICU mortality, length of stay in hospital and ICU, and readmission during hospital stay, were collected. Discharge time from ICU to wards and cut-offs at 7-day and 14-day were taken. Results: Four clusters were identified: A (consistently low SOFA scores), B (rapid increase followed by a decline in SOFA scores), C (higher baseline scores with gradual improvement), and D (persistently elevated scores). Cluster D had the longest ICU and hospital stays, highest ICU and hospital mortality. Discharge rates from ICU were similar for Clusters A and B, while Cluster C had initially comparable rates but a slower transition to ward. Conclusion: Monitoring dynamic changes in SOFA score is valuable for assessing sepsis severity and treatment responsiveness. Comment: 26 pages, 4 figures, 2 tables
Keywords	Quantitative Biology - Quantitative Methods ; Computer Science - Artificial Intelligence
Subject code	310
Publishing date	2023-11-23
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: P-Transformer

Ruan, Yucheng / Lan, Xiang / Tan, Daniel J. / Abdullah, Hairil Rizal / Feng, Mengling

A Prompt-based Multimodal Transformer Architecture For Medical Tabular Data

2023

Abstract: Medical tabular data, abundant in Electronic Health Records (EHRs), is a valuable resource for diverse medical tasks such as risk prediction. While deep learning approaches, particularly transformer-based models, have shown remarkable performance in ... ...

Abstract	Medical tabular data, abundant in Electronic Health Records (EHRs), is a valuable resource for diverse medical tasks such as risk prediction. While deep learning approaches, particularly transformer-based models, have shown remarkable performance in tabular data prediction, there are still problems remained for existing work to be effectively adapted into medical domain, such as under-utilization of unstructured free-texts, limited exploration of textual information in structured data, and data corruption. To address these issues, we propose P-Transformer, a Prompt-based multimodal Transformer architecture designed specifically for medical tabular data. This framework consists two critical components: a tabular cell embedding generator and a tabular transformer. The former efficiently encodes diverse modalities from both structured and unstructured tabular data into a harmonized language semantic space with the help of pre-trained sentence encoder and medical prompts. The latter integrates cell representations to generate patient embeddings for various medical tasks. In comprehensive experiments on two real-world datasets for three medical tasks, P-Transformer demonstrated the improvements with 10.9%/11.0% on RMSE/MAE, 0.5%/2.2% on RMSE/MAE, and 1.6%/0.8% on BACC/AUROC compared to state-of-the-art (SOTA) baselines in predictability. Notably, the model exhibited strong resilience to data corruption in the structured data, particularly when the corruption rates are high.
Keywords	Computer Science - Computation and Language
Subject code	006
Publishing date	2023-03-30
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Book ; Online: Enhancing Diagnostic Accuracy through Multi-Agent Conversations

Ke, Yu He / Yang, Rui / Lie, Sui An / Lim, Taylor Xin Yi / Abdullah, Hairil Rizal / Ting, Daniel Shu Wei / Liu, Nan

Using Large Language Models to Mitigate Cognitive Bias

2024

Abstract: Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. This study explores the role of large ... ...

Abstract	Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. This study explores the role of large language models (LLMs) in mitigating these biases through the utilization of a multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent system, we leveraged GPT-4 Turbo to facilitate interactions among four simulated agents to replicate clinical team dynamics. Each agent has a distinct role: 1) To make the initial and final diagnosis after considering the discussions, 2) The devil's advocate and correct confirmation and anchoring bias, 3) The tutor and facilitator of the discussion to reduce premature closure bias, and 4) To record and summarize the findings. A total of 80 simulations were evaluated for the accuracy of initial diagnosis, top differential diagnosis and final two differential diagnoses. Findings: In a total of 80 responses evaluating both initial and final diagnoses, the initial diagnosis had an accuracy of 0% (0/80), but following multi-agent discussions, the accuracy for the top differential diagnosis increased to 71.3% (57/80), and for the final two differential diagnoses, to 80.0% (64/80). The system demonstrated an ability to reevaluate and correct misconceptions, even in scenarios with misleading initial investigations. Interpretation: The LLM-driven multi-agent conversation system shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios. Comment: 22 pages, 3 figures
Keywords	Computer Science - Computation and Language ; Computer Science - Artificial Intelligence
Subject code	006
Publishing date	2024-01-25
Publishing country	us
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Discordant American Society of Anesthesiologists Physical Status Classification between anesthesiologists and surgeons and its correlation with adverse patient outcomes.

Kwa, Charlene Xian Wen / Cui, Jiaqian / Lim, Daniel Yan Zheng / Sim, Yilin Eileen / Ke, Yuhe / Abdullah, Hairil Rizal

Scientific reports

2022 Volume 12, Issue 1, Page(s) 7110

Abstract: The American Society of Anesthesiologists Physical Status Classification (ASA) is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ... ...

Abstract	The American Society of Anesthesiologists Physical Status Classification (ASA) is used for communication of patient health status, risk scoring, benchmarking and financial claims. Prior studies using hypothetical scenarios have shown poor concordance of ASA classification among healthcare providers. There is a paucity of studies using clinical data, and of clinical factors or patient outcomes associated with discordant classification. The study aims to assess ASA classification concordance between surgeons and anesthesiologists, factors surrounding discordance and its impact on patient outcomes. This retrospective cohort study was conducted in a tertiary medical center on 46,284 consecutive patients undergoing elective surgery between January 2017 and December 2019. The ASA class showed moderate concordance (weighted Cohen's κ 0.53) between surgeons and anesthesiologists. We found significant associations between discordant classification and patient comorbidities, age and race. Patients with discordant classification had a higher risk of 30-day mortality (odds ratio (OR) 2.00, 95% confidence interval (CI) = 1.52-2.62, p < 0.0001), 1-year mortality (OR 1.53, 95% CI = 1.38-1.69, p < 0.0001), and Intensive Care Unit admission > 24 h (OR 1.69, 95% CI = 1.47-1.94, p < 0.0001). Hence, there is a need for improved standardization of ASA scoring and cross-specialty review in ASA-discordant cases.
MeSH term(s)	Anesthesiologists ; Elective Surgical Procedures/adverse effects ; Humans ; Odds Ratio ; Retrospective Studies ; Surgeons ; United States/epidemiology
Language	English
Publishing date	2022-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-10736-5
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