Clinical Pathway Analysis Using Process Mining and Discrete-Event Simulation: an Application to Incisional Hernia

An incisional hernia (IH) is a ventral hernia that develops after surgical trauma to the abdominal wall, a laparotomy. IH repair is a common surgery that can generate chronic pain, decreased quality of life, and significant healthcare costs caused by hospital readmissions. The goal of this study is to analyze the clinical pathway of patients having an IH using a medico-administrative database. After a preliminary statistical analysis, a process mining approach is proposed to extract the most significant pathways from the database. The resulting causal net is converted into a statechart model that can be simulated. The model is used to understand times of occurrence of complications and associated costs. It enables the simulation of what-if scenarios to propose an improved care pathway for patients who are the most exposed, using in particular prophylactic mesh at the time of abdominal wall closure during a laparotomy on hospitalization costs and readmissions.