Construction of an online interactive calculation tool and corresponding risk stratification system for the probability of postoperative anastomotic leak in esophageal atresia based on machine learning algorithms

Wei Xiaoqin, Xiang Ming, Shen Yujie, Qiu Hongxiang, Liao Fuqing, Pan Zhengxia, Wu Chun, Xi Linyun

PDF(2500 KB)
PDF(2500 KB)
Journal of Chongqing Medical University ›› 2024, Vol. 49 ›› Issue (11) : 1457-1464. DOI: 10.13406/j.cnki.cyxb.003623
Clinical research

Construction of an online interactive calculation tool and corresponding risk stratification system for the probability of postoperative anastomotic leak in esophageal atresia based on machine learning algorithms

Author information +
History +

Abstract

Objective To predict postoperative anastomotic leak in esophageal atresia using machine learning techniques,to identify the risk factors for postoperative anastomotic leak,to calculate corresponding cut-off values,to develop an interactive web-based tool,and to help healthcare professionals quickly calculate the specific risk probability of postoperative anastomotic leak. Methods Clinical data were collected from 251 patients with type Ⅲ congenital esophageal atresia who underwent surgical treatment in our hospital from January 2009 to December 2021,including demographic features,surgical data,and postoperative data. Five machine learning algorithms,i.e.,support vector machine(SVM),random forest (RF),logistic regression(LR),XGBoost,and Gaussian naive Bayes(GNB),were used to construct a predictive model for anastomotic leak after esophageal atresia repair. The area under the ROC curve(AUC),F1 score,accuracy,sensitivity,and specificity were used to evaluate the validity of the model,the Hosmer-Lemeshow test and Brier score were used to evaluate the degree of calibration,and the decision curve analysis (DCA curve) was used to evaluate the degree of calibration and stability. Restricted cubic spline techniques were used to calculate the cut-off value of each risk factor,and then an interactive web-based calculation tool was developed to establish a risk stratification system for postoperative anastomotic leak,which was used to facilitate healthcare professionals in convenient application. Results The univariate analysis,importance ranking,and LASSO regression were performed for candidate risk factors,and the results showed that the distance between the ends of the esophageal gap,presence or absence of complex congenital heart disease,preoperative protein level,and presence or absence of pulmonary infection were the risk factors for postoperative anastomotic leak. Among the five machine learning algorithms,the logistic regression model exhibited the best performance in terms of AUC,DCA,and calibration curve,with an AUC of 0.828,an accuracy of 0.772,and an F1 score of 0.532 in the training set and an AUC of 0.799,an accuracy of 0.765,and an F1 score of 0.544 in the validation set,suggesting that the model had good discriminatory ability and degree of calibration in predicting postoperative anastomotic leak in type Ⅲcongenital esophageal atresia. Meanwhile,the restricted cubic spline analysis showed that the distance between the ends of the esophageal gap and preoperative protein level had a cut-off value of 2 cm and 33.9 g/L,respectively,and healthcare professionals could use the online interactive web-based tool to input the results of related risk factors and calculate the specific probability of postoperative anastomotic leak for a given patient. Conclusion The logistic regression model can predict the risk factors for postoperative anastomotic leak in patients with type Ⅲ congenital esophageal atresia,and the online interactive web-based tool is designed to quickly calculate the probability of postoperative anastomotic leak,thereby providing convenience for healthcare professionals.

Key words

esophageal atresia / machine learning / prediction

Cite this article

Download Citations
Wei Xiaoqin , Xiang Ming , Shen Yujie , et al . Construction of an online interactive calculation tool and corresponding risk stratification system for the probability of postoperative anastomotic leak in esophageal atresia based on machine learning algorithms. Journal of Chongqing Medical University. 2024, 49(11): 1457-1464 https://doi.org/10.13406/j.cnki.cyxb.003623

References

1
Spitz L Kiely E Brereton RJ. Esophageal atresia:five year experience with 148 cases[J]. J Pediatr Surg198722(2):103-108.
2
Hong SM Chen Q Cao H,et al. Developing a new predictive index for anastomotic leak following the anastomosis of esophageal atresia:preliminary results from a single centre[J]. J Cardiothorac Surg202217(1):131.
3
Bowder AN Lal DR. Advances in the surgical management of esophageal atresia[J]. Adv Pediatr202168:245-259.
4
Zhang LM Zhang F Xu FS,et al. Construction and evaluation of a sepsis risk prediction model for urinary tract infection[J]. Front Med20218:671184.
5
Xu FS Zhang LM Wang ZC,et al. A new scoring system for predicting In-hospital death in patients having liver cirrhosis with esophageal varices[J]. Front Med20218:678646.
6
Riley RD Ensor J Snell KIE,et al. Calculating the sample size required for developing a clinical prediction model[J]. BMJ2020368:m441.
7
Tan Tanny SP Beck C King SK,et al. Survival trends and syndromic esophageal atresia[J]. Pediatrics2021147(5):e2020029884.
8
Upadhyaya VD Gangopadhyaya AN Gupta DK,et al. Prognosis of congenital tracheoesophageal fistula with esophageal atresia on the basis of gap length[J]. Pediatr Surg Int200723(8):767-771.
9
Laberge JM Lévesque D Baird R. Anastomotic stricture after esophageal atresia repair:a critical review of recent literature[J]. Eur J Pediatr Surg201323(3):204-213.
10
Shah R Varjavandi V Krishnan U. Predictive factors for complications in children with esophageal atresia and tracheoesophageal fistula[J]. Dis Esophagus201528(3):216-223.
11
Nice TT Tuanama Diaz B Shroyer M,et al. Risk factors for stricture formation after esophageal atresia repair[J]. J Laparoendosc Adv Surg Tech A201626(5):393-398.
12
Michaud L Guimber D Sfeir R,et al. Anastomotic stenosis after surgical treatment of esophageal atresia:frequency,risk factors and effectiveness of esophageal dilatations[J]. Arch Pediatr20018(3):268-274.
13
Li Q Fan QL Han QX,et al. Machine learning in nephrology:scratching the surface[J]. Chin Med J2020133(6):687-698.
14
Kendale S Kulkarni P Rosenberg AD,et al. Supervised machine-learning predictive analytics for prediction of postinduction hypotension[J]. Anesthesiology2018129(4):675-688.
15
Hever G Cohen L O’Connor MF,et al. Machine learning applied to multi-sensor information to reduce false alarm rate in the ICU[J]. J Clin Monit Comput202034(2):339-352.
16
Lee S Mohr NM Street WN,et al. Machine learning in relation to emergency medicine clinical and operational scenarios:an overview[J]. West J Emerg Med201920(2):219-227.
17
Glaser JI Benjamin AS Farhoodi R,et al. The roles of supervised machine learning in systems neuroscience[J]. Prog Neurobiol2019175:126-137.

Comments

PDF(2500 KB)

Accesses

Citation

Detail

Sections
Recommended

/