Machine Learning-Based Analysis in the Management of Iatrogenic Bile Duct Injury During Cholecystectomy: a Nationwide Multicenter Study
Por:
Lopez-Lopez, V, Maupoey, J, Lopez-Andujar, R, Ramos, E, Mils, K, Martinez, PA, Valdivieso, A, Garces-Albir, M, Sabater, L, Valladares, LD, Perez, SA, Flores, B, Brusadin, R, Conesa, AL, Cayuela, V, Cortijo, SM, Paterna, S, Serrablo, A, Sanchez-Cabus, S, Gil, AG, Masia, JAG, Loinaz, C, Lucena, JL, Pastor, P, Garcia-Zamora, C, Calero, A, Valiente, J, Minguillon, A, Rotellar, F, Ramia, JM, Alcazar, C, Aguilo, J, Cutillas, J, Kuemmerli, C, Ruiperez-Valiente, JA, Robles-Campos, R
Publicada:
1 ago 2022
Ahead of Print:
1 jul 2022
Resumen:
Background Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. Methods This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. Results We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. Discussion Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.
Filiaciones:
Lopez-Lopez, V:
Virgen Arrixaca Clin & Univ Hosp, Murcian Inst Biosanit Res IMIB, Dept Surg & Transplantat, Ctra Madrid Cartagena,S-nEl Palmar, Murcia 30120, Spain
Maupoey, J:
Hosp Univ La Fe, Dept Hepatobiliary Surg & Transplants, Valencia, Spain
Lopez-Andujar, R:
Hosp Univ La Fe, Dept Hepatobiliary Surg & Transplants, Valencia, Spain
Ramos, E:
Univ Barcelona, Hosp Univ Bellvitge, Dept Hepatobiliary Surg & Liver Transplant Unit, Barcelona, Spain
Mils, K:
Univ Barcelona, Hosp Univ Bellvitge, Dept Hepatobiliary Surg & Liver Transplant Unit, Barcelona, Spain
Martinez, PA:
Univ Murcia, Dept Informat & Commun Engn, Murcia, Spain
Valdivieso, A:
Cruces Univ Hosp, Hepatobiliary Surg & Liver Transplant Unit, Bilbao, Spain
Garces-Albir, M:
Univ Valencia, Hosp Clin, Biomed Res Inst INCLIVA, Dept Surg, Valencia, Spain
Sabater, L:
Univ Valencia, Hosp Clin, Biomed Res Inst INCLIVA, Dept Surg, Valencia, Spain
Valladares, LD:
Hosp Clin San Carlos, Dept Surg, Hepatopancreatobiliary Unit, Madrid, Spain
Perez, SA:
Morales Univ Hosp, Dept Surg, Madrid, Spain
Flores, B:
Morales Univ Hosp, Dept Surg, Madrid, Spain
Brusadin, R:
Virgen Arrixaca Clin & Univ Hosp, Murcian Inst Biosanit Res IMIB, Dept Surg & Transplantat, Ctra Madrid Cartagena,S-nEl Palmar, Murcia 30120, Spain
Conesa, AL:
Virgen Arrixaca Clin & Univ Hosp, Murcian Inst Biosanit Res IMIB, Dept Surg & Transplantat, Ctra Madrid Cartagena,S-nEl Palmar, Murcia 30120, Spain
Cayuela, V:
Virgen Arrixaca Clin & Univ Hosp, Murcian Inst Biosanit Res IMIB, Dept Surg & Transplantat, Ctra Madrid Cartagena,S-nEl Palmar, Murcia 30120, Spain
Cortijo, SM:
Alcorcon Univ Hosp, Dept Surg, Madrid, Spain
Paterna, S:
Miguel Servet Univ Hosp, Dept Surg, Zaragoza, Spain
Serrablo, A:
Miguel Servet Univ Hosp, Dept Surg, Zaragoza, Spain
Sanchez-Cabus, S:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Hepatobiliopancreat Surg Unit, Barcelona, Spain
Gil, AG:
Los Arcos Mar Menor Univ Hosp, Dept Surg, Murcia, Spain
Masia, JAG:
Gen Univ Hosp, Dept Surg, Albacete, Spain
Loinaz, C:
Hosp Univ 12 Octubre, Dept Gen Surg Digest Tract & Abdominal Organ Tran, Madrid, Spain
Lucena, JL:
Puerta Hierro Univ Hosp, Dept Surg, Madrid, Spain
Pastor, P:
Reina Sofia Univ Hosp, Dept Surg, Murcia, Spain
Garcia-Zamora, C:
Rafael Mendez Hosp, Dept Surg, Murcia, Spain
Calero, A:
Univ Miguel Hernandez Elche, Elche Univ Hosp, Dept Gen Surg, Alicante, Spain
Valiente, J:
Univ Murcia, Dept Informat & Commun Engn, Murcia, Spain
Hellin Hosp, Dept Gen Surg, Albacete, Spain
Minguillon, A:
Obispo Polanco Hosp, Dept Gen Surg, Teruel, Spain
Rotellar, F:
Univ Navarra, Clin Univ Navarra, Dept Gen Surg, HPB & Liver Transplant Unit, Pamplona, Spain
Inst Hlth Res Navarra IdisNA, Pamplona, Spain
Ramia, JM:
Dr Balmis Gen Univ Hosp, HPB Surg & Liver Transplantat, Alicante, Spain
Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Alcazar, C:
Dr Balmis Gen Univ Hosp, HPB Surg & Liver Transplantat, Alicante, Spain
Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Aguilo, J:
Hosp Lluis Alcanyis Hosp, Dept Gen Surg, Valencia, Spain
Cutillas, J:
Hosp Francesc Borja, Dept Gen Surg, Valencia, Spain
Kuemmerli, C:
Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland
Clarunis Univ Ctr Gastrointestinal & Liver Dis, Dept Surg, Basel, Switzerland
Ruiperez-Valiente, JA:
Univ Murcia, Dept Informat & Commun Engn, Murcia, Spain
Robles-Campos, R:
Virgen Arrixaca Clin & Univ Hosp, Murcian Inst Biosanit Res IMIB, Dept Surg & Transplantat, Ctra Madrid Cartagena,S-nEl Palmar, Murcia 30120, Spain
Green Published, hybrid, All Open Access, Hybrid Gold, Green
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