US healthcare is undergoing a rapid evolution with a renewed focus on improving healthcare at a reduced cost. Surgery, which has always been a high-risk undertaking, has been at the nexus of this evolution. Even though the cost of surgical complications in the United States can be estimated to be $87 BN dollars, current surgical risk assessment is complicated and non-uniform: each patient is unique, and identifying all of the factors that may affect surgical outcome is difficult. Established methods are limited in scope and require large patient populations as well as significant time to execute. Moreover, current risk-assessment methods incorporate the subjective assessments of clinicians, cannot be applied to individual patients, and do not take into account the dynamic nature of changing patient populations and practice patterns in health care systems. Recently, data collection during surgery has proven to be a rich resource to begin systematic evaluation of the perioperative factors that influence the outcome of non-cardiac surgery, allowing researchers and clinicians to map complex physiological factors over the perioperative period and identify common trajectories taken by patients from admission to outcome.
Description
A novel profiling system, the Triple Variable Index (TVI), will allow clinicians to predict outcomes and stage timely interventions by integrating data representing cardiovascular and neurologic system functions moment-to-moment for individual patients responding to anesthetics and surgery. The TVI system measures mean arterial pressure (MAP), Bispectral Index (BIS), and minimum alveolar concentration (MAC), revealing a distinct pattern of organ system function. These measurements show the tightly regulated functions of multiple organ systems that work in concert to maintain homeostatic balance, and mapping their function over time yields connections to postoperative outcomes. The TVI method provides rapid analysis on an individual basis for a wide population of surgical patients. Surgical cases can be separated into distinct clusters combining Triple Variable Indexing and K-means cluster analysis based on one of three possible physiological states during surgery represented by an elevated, mixed, or depressed TVI value; further, TVI depression has been shown to correlate with postoperative mortality. These developments will allow clinicians to identify potential points of clinical interventions in a timely manner to decrease patient risk of postoperative death, as well as reducing costs for patients and care providers alike.
Applications
· Real-time risk prediction for perioperative outcomes in patients undergoing general anesthesia
· Allows clinicians to stage timely, effective interventions post-surgery
Advantages
· MAP, MAC, and BIS data are easy to access and are measured via non-invasive procedures
· A TVI profile can be generated for any patient where MAP, MAC, and BIS data are available; it may be possible to infer BIS values if only MAP and MAC data exist
· TVI is mapped moment-to-moment, allowing real-time analysis and the ability to stage time-sensitive surgical interventions
· Does not rely on the subjective assessment of clinicians and is patient-specific
Invention Readiness
Prototype
IP Status
https://patents.google.com/patent/US20190046122A1
