Ahmed Mohamed1, Ashfaq Shuaib2, Ayman Z Ahmed3, Maher Saqqur4, Nida Fatima5. 1. Department of Biology (Physiology), McMaster University, Hamilton, ON, Canada. 2. Department of Neurology, University of Alberta, Edmonton, AB, Canada. 3. Department of Neuroscience, Hamad General Hospital, Doha, Qatar. 4. Department of Neuroscience, MSK Trillium Hospital, Institute for Better Health, University of Toronto at Mississauga, Mississauga, ON, Canada. 5. Division of Neurosurgery, House Institute, Los Angeles, CA, USA. fnida99@yahoo.com.
Abstract
BACKGROUND: Preoperative prognostication of 30-day mortality in patients with carotid endarterectomy (CEA) can optimize surgical risk stratification and guide the decision-making process to improve survival. This study aims to develop and validate a set of predictive variables of 30-day mortality following CEA. METHODS: The patient cohort was identified from the American College of Surgeons National Surgical Quality Improvement Program (2005-2016). We performed logistic regression (enter, stepwise, and forward) and least absolute shrinkage and selection operator (LASSO) method for the selection of variables, which resulted in 28-candidate models. The final model was selected based upon clinical knowledge and numerical results. RESULTS: Statistical analysis included 65,807 patients with 30-day mortality in 0.7% (n = 466) patients. The median age of our cohort was 71.0 years (range, 16-89 years). The model with 9 predictive factors which included age, body mass index, functional health status, American Society of Anesthesiologist grade, chronic obstructive pulmonary disorder, preoperative serum albumin, preoperative hematocrit, preoperative serum creatinine, and preoperative platelet count-performed best on discrimination, calibration, Brier score, and decision analysis to develop a machine learning algorithm. Logistic regression showed higher AUCs than LASSO across these different models. The predictive probability derived from the best model was converted into an open-accessible scoring system. CONCLUSION: Machine learning algorithms show promising results for predicting 30-day mortality following CEA. These algorithms can be useful aids for counseling patients, assessing preoperative medical risks, and predicting survival after surgery.
BACKGROUND: Preoperative prognostication of 30-day mortality in patients with carotid endarterectomy (CEA) can optimize surgical risk stratification and guide the decision-making process to improve survival. This study aims to develop and validate a set of predictive variables of 30-day mortality following CEA. METHODS: The patient cohort was identified from the American College of Surgeons National Surgical Quality Improvement Program (2005-2016). We performed logistic regression (enter, stepwise, and forward) and least absolute shrinkage and selection operator (LASSO) method for the selection of variables, which resulted in 28-candidate models. The final model was selected based upon clinical knowledge and numerical results. RESULTS: Statistical analysis included 65,807 patients with 30-day mortality in 0.7% (n = 466) patients. The median age of our cohort was 71.0 years (range, 16-89 years). The model with 9 predictive factors which included age, body mass index, functional health status, American Society of Anesthesiologist grade, chronic obstructive pulmonary disorder, preoperative serum albumin, preoperative hematocrit, preoperative serum creatinine, and preoperative platelet count-performed best on discrimination, calibration, Brier score, and decision analysis to develop a machine learning algorithm. Logistic regression showed higher AUCs than LASSO across these different models. The predictive probability derived from the best model was converted into an open-accessible scoring system. CONCLUSION: Machine learning algorithms show promising results for predicting 30-day mortality following CEA. These algorithms can be useful aids for counseling patients, assessing preoperative medical risks, and predicting survival after surgery.
Authors: A R Naylor; J-B Ricco; G J de Borst; S Debus; J de Haro; A Halliday; G Hamilton; J Kakisis; S Kakkos; S Lepidi; H S Markus; D J McCabe; J Roy; H Sillesen; J C van den Berg; F Vermassen; P Kolh; N Chakfe; R J Hinchliffe; I Koncar; J S Lindholt; M Vega de Ceniga; F Verzini; J Archie; S Bellmunt; A Chaudhuri; M Koelemay; A-K Lindahl; F Padberg; M Venermo Journal: Eur J Vasc Endovasc Surg Date: 2017-08-26 Impact factor: 7.069
Authors: Michiel H F Poorthuis; Reinier A R Herings; Kirsten Dansey; Johanna A A Damen; Jacoba P Greving; Marc L Schermerhorn; Gert J de Borst Journal: Stroke Date: 2021-10-12 Impact factor: 7.914