Development and multicenter validation of machine learning models for predicting postoperative pulmonary complications after neurosurgery.
10.1097/CM9.0000000000003433
- Author:
Ming XU
1
;
Wenhao ZHU
1
;
Siyu HOU
1
;
Hongzhi XU
2
;
Jingwen XIA
3
;
Liyu LIN
4
;
Hao FU
5
;
Mingyu YOU
5
;
Jiafeng WANG
6
;
Zhi XIE
7
;
Xiaohong WEN
8
;
Yingwei WANG
1
Author Information
1. Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai 200040, China.
2. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
3. Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.
4. State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China.
5. Department of Control Science and Engineering, College of Electronic and Information Engineering, Tongji University, Shanghai 201804, China.
6. Department of Anesthesiology, Changhai Hospital, Navy Medical University, Shanghai 200433, China.
7. Department of Anesthesiology, Shanghai Neuromedical Center, Shanghai 200331, China.
8. Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China.
- Publication Type:Validation Study
- Keywords:
Deep neural network;
Machine learning;
Neurosurgery;
Postoperative pulmonary complications;
Prediction model
- MeSH:
Adult;
Aged;
Female;
Humans;
Male;
Middle Aged;
Algorithms;
Lung Diseases/etiology*;
Machine Learning;
Neurosurgical Procedures/adverse effects*;
Postoperative Complications/diagnosis*;
Risk Factors;
ROC Curve
- From:
Chinese Medical Journal
2025;138(17):2170-2179
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery.
METHODS:PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed.
RESULTS:PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model.
CONCLUSIONS:The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes.
TRIAL REGISTRATION:ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
