Integrating StEP-COMPAC definition and enhanced recovery after surgery status in a machine-learning-based model for postoperative pulmonary complications in laparoscopic hepatectomy

作者：Sibei Li, Yaxin Lu, Hong Zhang, Chuzhou Ma, Xiao Han, Zifeng Liu, Shaoli Zhou, Chaojin Chen · 发表于：Anaesthesia Critical Care & Pain Medicine · 年份：2024 · DOI：10.1016/j.accpm.2024.101424 · 被引用次数：6 · 研究领域：Enhanced Recovery After Surgery、Hepatocellular Carcinoma Treatment and Prognosis、Lung Cancer Diagnosis and Treatment

BACKGROUND: Postoperative pulmonary complications (PPCs) contribute to high mortality rates and impose significant financial burdens. In this study, a machine learning-based prediction model was developed to identify patients at high risk of developing PPCs following laparoscopic hepatectomy. METHODS: Data were collected from 1022 adult patients who underwent laparoscopic hepatectomy at two centres between January 2015 and February 2021. The dataset was divided into a development set and a temporal external validation set based on the year of surgery. A total of 42 factors were extracted for pre-modelling, including the implementation status of Enhanced Recovery after Surgery (ERAS). Feature selection was performed using the least absolute shrinkage and selection operator (LASSO) method. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). The model with the best performance was externally validated using temporal data. RESULTS: The incidence of PPCs was 8.7%. Lambda.1se was selected as the optimal lambda for LASSO feature selection. For implementation of ERAS, serum gamma-glutamyl transferase levels, malignant tumour presence, total bilirubin levels, and age-adjusted Charleston Comorbidities Index were the selected factors. Seven models were developed. Among them, logistic regression demonstrated the best performance, with an AUC of 0.745 in the internal validation set and 0.680 in the temporal external validation set. CONCLU...