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A risk scoring system integrating postoperative factors for predicting early mortality after major non-cardiac surgery

 Dongwoo Chae  ;  Na Young Kim  ;  Hyun Joo Kim  ;  Tae Lim Kim  ;  Su Jeong Kang  ;  So Yeon Kim 
 Clinical and Translational Science, Vol.15(9) : 2230-2240, 2022-09 
Journal Title
Clinical and Translational Science
Issue Date
Humans ; Lymphocyte Count ; Postoperative Complications* / diagnosis ; Postoperative Complications* / etiology ; Retrospective Studies ; Risk Factors ; Serum Albumin*
We aimed to develop a risk scoring system for 1-week and 1-month mortality after major non-cardiac surgery, and assess the impact of postoperative factors on 1-week and 1-month mortality using machine learning algorithms. We retrospectively reviewed the medical records of 21,510 patients who were transfused with red blood cells during non-cardiac surgery and collected pre-, intra-, and postoperative features. We derived two patient cohorts to predict 1-week and 1-month mortality and randomly split each of them into training and test cohorts at a ratio of 8:2. All the modeling steps were carried out solely based on the training cohorts, whereas the test cohorts were reserved for the evaluation of predictive performance. Incorporation of postoperative information demonstrated no significant benefit in predicting 1-week mortality but led to substantial improvement in predicting 1-month mortality. Risk scores predicting 1-week and 1-month mortality were associated with area under receiver operating characteristic curves of 84.58% and 90.66%, respectively. Brain surgery, amount of intraoperative red blood cell transfusion, preoperative platelet count, preoperative serum albumin, and American Society of Anesthesiologists physical status were included in the risk score predicting 1-week mortality. Postoperative day (POD) 5 (neutrophil count × mean platelet volume) to (lymphocyte count × platelet count) ratio, preoperative and POD 5 serum albumin, and occurrence of acute kidney injury were included in the risk score predicting 1-month mortality. Our scoring system advocates the importance of postoperative complete blood count differential and serum albumin to better predict mortality beyond the first week post-surgery.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pharmacology (약리학교실) > 1. Journal Papers
Yonsei Authors
Kim, Na Young(김나영) ORCID logo https://orcid.org/0000-0003-3685-2005
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Kim, Tae Lim(김태림) ORCID logo https://orcid.org/0000-0001-9421-7486
Kim, Hyun Joo(김현주) ORCID logo https://orcid.org/0000-0003-1963-8955
Chae, Dong Woo(채동우) ORCID logo https://orcid.org/0000-0002-7675-3821
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