Distinguishing surgical behavior by sequential pattern discovery

Objective: Each surgical procedure is unique due to patient's and also surgeon's particularities. In this study, we propose a new approach to distinguish surgical behaviors between surgical sites, levels of expertise and individual surgeons thanks to a pattern discovery method. Methods: The developed approach aims to distinguish surgical behaviors based on shared longest frequent sequential patterns between surgical process models. To allow clustering, we propose a new metric called SLFSP. The approach is validated by comparison with a clustering method using Dynamic Time Warping as a metric to characterize the similarity between surgical process models. Results: Our method outperformed the existing approach. It was able to make a perfect distinction between surgical sites (accuracy of 100%). We reached an accuracy superior to 90% and 85% for distinguishing levels of expertise and individual surgeons. Conclusion: Clustering based on shared longest frequent sequential patterns outperformed the previous study based on time analysis. Significance: The proposed method shows the feasibility of comparing surgical process models, not only by their duration but also by their structure of activities. Furthermore, patterns may show risky behaviors, which could be an interesting information for surgical training to prevent adverse events. (C) 2017 Elsevier Inc. All rights reserved.