Forecasting Intraoperative Hypotension During Hepatobiliary Surgery

Authors

Juan P Cata
Bhavin Soni
Shreyas Bhavsar
Parvathy Sudhir Pillai
Tatiana A Rypinski
Anshuj Deva
Jeffrey H Siewerdsen
Jose M Soliz

Publication Date

2-1-2025

Journal

Journal of Clinical Monitoring and Computing

Abstract

Prediction and avoidance of intraoperative hypotension (IOH) can lead to less postoperative morbidity. Machine learning (ML) is increasingly being applied to predict IOH. We hypothesize that incorporating demographic and physiological features in an ML model will improve the performance of IOH prediction. In addition, we added a "dial" feature to alter prediction performance. An ML prediction model was built based on a multivariate random forest (RF) trained algorithm using 13 physiologic time series and patient demographic data (age, sex, and BMI) for adult patients undergoing hepatobiliary surgery. A novel implementation was developed with an adjustable, multi-model voting (MMV) approach to improve performance in the challenging context of a dynamic, sliding window for which the propensity of data is normal (negative for IOH). The study cohort included 85% of subjects exhibiting at least one IOH event. Males constituted 70% of the cohort, median age was 55.8 years, and median BMI was 27.7. The multivariate model yielded average AUC = 0.97 in the static context of a single prediction made up to 8 min before a possible IOH event, and it outperformed a univariate model based on MAP-only (average AUC = 0.83). The MMV model demonstrated AUC = 0.96, PPV = 0.89, and NPV = 0.98 within the challenging context of a dynamic sliding window across 40 min prior to a possible IOH event. We present a novel ML model to predict IOH with a distinctive "dial" on sensitivity and specificity to predict first IOH episode during liver resection surgeries.

Keywords

Humans, Male, Female, Middle Aged, Hypotension, Machine Learning, Algorithms, Aged, Adult, Monitoring, Intraoperative, Intraoperative Complications, Body Mass Index, Biliary Tract Surgical Procedures, Forecasting, Liver, Cohort Studies, Blood Pressure

DOI

10.1007/s10877-024-01223-5

PMID

39317921

PMCID

PMC11821686

PubMedCentral® Posted Date

9-24-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes