Application of Data Mining Techniques for National Health Insurance Research Database Analysis to Develop Risk Assessment System of Major Postoperative Complications

BACKGROUND: Postoperative complications not only affect patients’ recovery and delay the timing of hospital discharge, but also induce a substantial increase of medical costs. The purpose of this study is to investigate postoperative major complications and mortality in surgical patients with asthma. METHODS: Using reimbursement claims from the Taiwan National Health Insurance Research Database, we identified 24,109 surgical patients with preoperative asthma and 24,109 non-asthma patients undergoing major surgeries using matching procedure with propensity score by sociodemographics, coexisting medical conditions and surgical characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day postoperative complications and mortality associated with asthma were analyzed in the multivariate logistic regressions. RESULTS: Asthma increased postoperative pneumonia (OR = 1.48), septicemia (OR = 1.11) and urinary tract infection (OR = 1.17). Preoperative emergency care for asthma was significantly associated with postoperative 30-day in-hospital mortality, with an OR of 1.84. Preoperative emergency service, hospitalizations, admission to intensive care unit and systemic use of corticosteroids for asthma were also associated with higher postoperative complication rates for asthmatic patients. CONCLUSIONS: Our findings showed patients with asthma had higher risks of postoperative pneumonia, septicemia, and urinary tract infection when compared with nonasthmatic patients. Among surgical patients with asthma, preoperative emergency visits, hospitalizations, or ICU stay due to asthma significantly increased postoperative adverse events. Preoperative use of systemic corticosteroids was also identified as an independent risk factor for postoperative complications and mortality. Postoperative complications and mortality were significantly increased in asthmatic patients. We suggest urgent efforts to revise protocols for asthma patients’ perioperative care.