Development of machine learning and multivariable models for predicting blood transfusion in head and neck microvascular reconstruction for risk‐stratified patient blood management

Head & Neck, vol. 45, pp. 1389–1405

Abstract

BACKGROUND: Although blood transfusions have adverse consequences for microvascular head and neck reconstruction, they are frequently administered. Pre-identifying patients would allow risk-stratified patient blood management. METHODS: Development of machine learning (ML) and logistic regression (LR) models based on retrospective inclusion of 657 patients from 2011 to 2021. Internal validation and comparison with models from the literature by external validation. Development of a web application and a score chart. RESULTS: Our models achieved an area under the receiver operating characteristic curve (ROC-AUC) of up to 0.825, significantly outperforming LR models from the literature. Preoperative hemoglobin, blood volume, duration of surgery and flap type/size were strong predictors. CONCLUSIONS: The use of additional variables improves the prediction for blood transfusion, while models seems to have good generalizability due to surgical standardization and underlying physiological mechanism. The ML models developed showed comparable predictive performance to an LR model. However, ML models face legal hurdles, whereas score charts based on LR could be used after further validation.

Authors 8

1. Behrus Puladi corresponding Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery University Hospital RWTH Aachen Aachen Germany

   Institute of Medical Informatics University Hospital RWTH Aachen Aachen Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen Aachen Germany

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen, Aachen, Germany

2. Mark Ooms Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery University Hospital RWTH Aachen Aachen Germany

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany

3. Annette Dorothea Rieg Aachen Department of Anaesthesiology

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Anaesthesiology University Hospital RWTH Aachen Aachen Germany

   Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany

4. Max Taubert

   University of Cologne

   Affiliation as printed

   Center for Pharmacology, Department I of Pharmacology Medical Faculty, University of Cologne Cologne Germany

   Center for Pharmacology, Department I of Pharmacology, Medical Faculty, University of Cologne, Cologne, Germany

5. Ashkan Rashad Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics University Hospital RWTH Aachen Aachen Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen Aachen Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen, Aachen, Germany

6. Frank Hölzle Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics University Hospital RWTH Aachen Aachen Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen Aachen Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen, Aachen, Germany

7. Rainer Röhrig Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics University Hospital RWTH Aachen Aachen Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen Aachen Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, Germany

   SMITH Consortium of the German Medical Informatics Initiative in Aachen, Aachen, Germany

8. Ali Modabber Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery University Hospital RWTH Aachen Aachen Germany

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany