A precise blood transfusion evaluation model for aortic surgery: a single-center retrospective study.

Journal: Journal of clinical monitoring and computing
PMID:

Abstract

Cardiac aortic surgery is an extremely complicated procedure that often requires large volume blood transfusions during the operation. Currently, it is not possible to accurately estimate the intraoperative blood transfusion volume before surgery. Therefore, in this study, to determine the clinically precise usage of blood for intraoperative blood transfusions during aortic surgery, we established a predictive model based on machine learning algorithms. We performed a retrospective analysis on 4,285 patients who received aortic surgery in Beijing Anzhen Hospital between January 2018 and September 2022. Ultimately, 3,654 patients were included in the study, including 2,557 in the training set and 1,097 in the testing set. By utilizing 13 current mainstream models and a large-scale cardiac aortic surgery dataset, we built a novel machine learning model for accurately predicting intraoperative red blood cell transfusion volume. Based on the transfusion-related risk factors that the model identified, we also established the relevant variables that affected the results. The results revealed that decision tree models were the most suitable for predicting the blood transfusion volume during aortic surgery. In particular, the mean absolute error for the best-performing extremely randomized forest model was 1.17 U, while the R value was 0.50. Further exploration into intraoperative blood transfusion during aortic surgery identified erythrocytes, estimated operation duration, body weight, sex, red blood cell count, and D-dimer as the six most significant risk factors. These factors were subsequently analyzed for their influence on intraoperative blood transfusion volume in relevant patients, as well as the protective threshold for prediction. The novel intraoperative blood transfusion prediction model for cardiac aorta surgery in this study effectively assists clinicians in accurately calculating blood transfusion volumes and achieving effective utilization of blood resources. Furthermore, we utilize interpretability technology to reveal the influence of critical risk factors on intraoperative blood transfusion volume, which provides an important reference for physicians to provide timely and effective interventions. It also enables personalized and precise intraoperative blood usage.

Authors

  • Ji Che
    Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. chejizy@163.com.
  • Bo Yang
    Center for Cognition and Brain Disorders, Hangzhou Normal University, Hangzhou, Zhejiang Province 311121, China.
  • Yan Xie
    Key laboratory of Transplantation, Chinese Academy of Medical Sciences, Tianjin, 300192, China; Tianjin Key Laboratory for Organ Transplantation, Tianjin First Center Hospital, Tianjin, 300192, China; Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin, 300192, China; Tianjin Key Laboratory of Molecular and Treatment of Liver Cancer, Tianjin First Center Hospital, Tianjin, 300192, China.
  • Lei Wang
    Department of Nursing, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
  • Ying Chang
    Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  • Jianguo Han
    Department of Transfusion, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
  • Hui Zhang
    Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.