The goals of the research
In 2018, we received a query from The French Association of Surgeons.
The goal of the research was to compare the results of a new Cesarean section technique (FAUCS) with the "gold standard" technique (STARK).
We had to find the answers to two main questions:
- Is the new technique of interest to patients, in terms of pain, recovery, satisfaction, and length of hospital stay?
- What are the complications, the operative times, and difficulties of the technique experienced by surgeons?
Technologies and sources
We were provided with the anonymized database of hundreds of surgery cases and more than 60 subjective and objective characteristics.
The main instruments we used were R language, correlations tests, and machine learning techniques.
The independent sample t-test, in conjunction with the F-test, was used.
Our work process was divided into four main stages:
- Check the data prepared by our client for reliability
- Conduct correlations tests and combine items using machine learning techniques
- Prepare tables, graphs, and p-values
- Provide a text description of the results ready for use in a scientific journal article
The research findings
1. Mother’s autonomy analysis
To conduct a mother’s autonomy analysis, we determined ten main characteristics from the client's database, such as time of the first stand-up in hours; transit recovery time in days; pain or dizziness felt on the first stand-up, etc.
The time between the end of the operation and the first full meal
We conducted the correlation analysis and found a strong correlation between the Caesarean technique used and the time between the end of the operation and the new mother’s first full meal.
With 95% confidence, one can assert that the FAUCS technique patients usually have their first full meal between 16,7 and 23,0 hours earlier than the STARK technique patients.
Time of first stand up
With the help of F-test and t-test, we concluded that the FAUCS patients usually stand up for the first time 7.7-11.9 hours earlier than the STARK patients.
Pain felt on the first stand-up
The results of t-test show that there are statistically significant differences in the means of the level of pain on the first stand-up, grouped by the Cesarean technique used.
With 95% confidence, one can assert that the FAUCS patients usually feel less strong pain (1.8-3.5 points less) than the STARK technique patients.
We also concluded that other indicators of mother autonomy – such as a delay between the end of the operation and the first spontaneous urination and transit recovery time – had a low correlation with the Cesarean technique used.
We also determined and didn’t take into account in the further analysis the indicators that had a negligible correlation with Cesarean section technique. These included dizziness felt on the first stand-up; help needed to carry the baby; delay between intervention and first breastfeeding; difficulty with breastfeeding; and help required by patient on first stand-up.
2. Mother’s wellbeing analysis
In this part of the research, we studied the use of anticoagulants, analgesics, post-operative pain and the impression that the mother was actively involved in the delivery.
Anticoagulants by low molecular weight heparin
We conducted that the FAUCS patients need anticoagulants less often than the STARK patients.
Impression that the mother was actively involved in the delivery
69.21% of the variance of mother involvement in the delivery can be explained by the method used to perform Cesarean section. The negative value of correlation in this case (r = -0.6921) indicates that the patients that the FAUCS patients are usually less involved in the process of delivery than the STARK patients.
The positive value of correlation, in this case (r = 0.5838), means that the post-operative FAUCS patients need post-operative analgesics less often, and, if they need them, the medications are less strong.
Post-operative pain out of ten points
We concluded that FAUCS patients feel less strong post-operative pain (0.5-1.9 points less) than the STARK patients.
3. Overall morbidity analysis
Effective date of discharge from hospital
The positive value of correlation (r = 0.5241) means that the FAUCS patients are usually discharged earlier than STARK patients.
During the correlation analysis, a number of other factors that influenced the mothers’ autonomy, wellbeing, and overall morbidity were found.
To statistically confirm that the Cesarean section method alone reflects the influence of control variables, a principal component analysis was performed. The results are presented in the table below:
The Caesarean section technique explains 79,73% of the variance among the variables mentioned above.
The results achieved
The research was conducted for two weeks by three data scientists with assistance from a Doctor of Science from Singularex.
Their main findings were:
- We found no statistically significant differences between the 2 samples (FAUCS and STARK) of research subjects. The only exception was emergency cases.
- FAUCS technique is of more interest to patients, in terms of pain and recovery. It reduces the time between the end of the operation and the first full meal to 16,7-23,0 hours; time of first post-surgery stand-up to 7.7-11.9 hours; and pain to 1.8-3.5 points.
- The FAUCS technique also reduces the need to use anticoagulants by low molecular weight heparin, which reflects the better well-being of patients after surgery. There is also a moderate connection between the use of the FAUCS technique and the need to use fewer postoperative analgesics. If they are used, the medications are less strong.
- No patients who underwent STARK surgery were discharged from the hospital within 24 hours, while 70% of patients who underwent FAUCS were discharged in this period of time.
- When FAUCS is used, mothers usually are less involved in the delivery process.
- We determined a weak correlation between the technique used and variables such as delay between the end of the operation; the first spontaneous urination; and transit recovery time. The use of new technique has practically no effect on the need for help to stand up or carry the baby or the process of breastfeeding.
The results of the research prove that the hypothesis about the positive impact of the FAUCS technique on surgery is confirmed and should be a subject for further research.