Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery
There is no well-defined threshold for intra-operative blood transfusion (BT) in advanced epithelial ovarian cancer (EOC) surgery. To address this, we devised a Machine Learning (ML)-driven prediction algorithm aimed at prompting and elucidating a communication alert for BT based on anticipated peri...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/14/1/94 |
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| author | Alexandros Laios Evangelos Kalampokis Marios-Evangelos Mamalis Amudha Thangavelu Yong Sheng Tan Richard Hutson Sarika Munot Tim Broadhead David Nugent Georgios Theophilou Robert-Edward Jackson Diederick De Jong |
| author_facet | Alexandros Laios Evangelos Kalampokis Marios-Evangelos Mamalis Amudha Thangavelu Yong Sheng Tan Richard Hutson Sarika Munot Tim Broadhead David Nugent Georgios Theophilou Robert-Edward Jackson Diederick De Jong |
| author_sort | Alexandros Laios |
| collection | DOAJ |
| description | There is no well-defined threshold for intra-operative blood transfusion (BT) in advanced epithelial ovarian cancer (EOC) surgery. To address this, we devised a Machine Learning (ML)-driven prediction algorithm aimed at prompting and elucidating a communication alert for BT based on anticipated peri-operative events independent of existing BT policies. We analyzed data from 403 EOC patients who underwent cytoreductive surgery between 2014 and 2019. The estimated blood volume (EBV), calculated using the formula EBV = weight × 80, served for setting a 10% EBV threshold for individual intervention. Based on known estimated blood loss (EBL), we identified two distinct groups. The Receiver operating characteristic (ROC) curves revealed satisfactory results for predicting events above the established threshold (AUC 0.823, 95% CI 0.76–0.88). Operative time (OT) was the most significant factor influencing predictions. Intra-operative blood loss exceeding 10% EBV was associated with OT > 250 min, primary surgery, serous histology, performance status 0, R2 resection and surgical complexity score > 4. Certain sub-procedures including large bowel resection, stoma formation, ileocecal resection/right hemicolectomy, mesenteric resection, bladder and upper abdominal peritonectomy demonstrated clear associations with an elevated interventional risk. Our findings emphasize the importance of obtaining a rough estimate of OT in advance for precise prediction of blood requirements. |
| first_indexed | 2024-03-08T15:09:33Z |
| format | Article |
| id | doaj.art-9b03dadb1cb64953932edce73aee2437 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-08T15:09:33Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-9b03dadb1cb64953932edce73aee24372024-01-10T14:53:58ZengMDPI AGDiagnostics2075-44182023-12-011419410.3390/diagnostics14010094Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive SurgeryAlexandros Laios0Evangelos Kalampokis1Marios-Evangelos Mamalis2Amudha Thangavelu3Yong Sheng Tan4Richard Hutson5Sarika Munot6Tim Broadhead7David Nugent8Georgios Theophilou9Robert-Edward Jackson10Diederick De Jong11Department of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Business Administration, University of Macedonia, 54636 Thessaloniki, GreeceDepartment of Business Administration, University of Macedonia, 54636 Thessaloniki, GreeceDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Anaesthesia, St James’s University Hospital, Leeds LS9 7TF, UKDepartment of Gynaecologic Oncology, St James’s University Hospital, Leeds LS9 7TF, UKThere is no well-defined threshold for intra-operative blood transfusion (BT) in advanced epithelial ovarian cancer (EOC) surgery. To address this, we devised a Machine Learning (ML)-driven prediction algorithm aimed at prompting and elucidating a communication alert for BT based on anticipated peri-operative events independent of existing BT policies. We analyzed data from 403 EOC patients who underwent cytoreductive surgery between 2014 and 2019. The estimated blood volume (EBV), calculated using the formula EBV = weight × 80, served for setting a 10% EBV threshold for individual intervention. Based on known estimated blood loss (EBL), we identified two distinct groups. The Receiver operating characteristic (ROC) curves revealed satisfactory results for predicting events above the established threshold (AUC 0.823, 95% CI 0.76–0.88). Operative time (OT) was the most significant factor influencing predictions. Intra-operative blood loss exceeding 10% EBV was associated with OT > 250 min, primary surgery, serous histology, performance status 0, R2 resection and surgical complexity score > 4. Certain sub-procedures including large bowel resection, stoma formation, ileocecal resection/right hemicolectomy, mesenteric resection, bladder and upper abdominal peritonectomy demonstrated clear associations with an elevated interventional risk. Our findings emphasize the importance of obtaining a rough estimate of OT in advance for precise prediction of blood requirements.https://www.mdpi.com/2075-4418/14/1/94epithelial ovarian cancercomplete cytoreductionestimated blood lossestimated blood volumeblood transfusionintra-operative mapping |
| spellingShingle | Alexandros Laios Evangelos Kalampokis Marios-Evangelos Mamalis Amudha Thangavelu Yong Sheng Tan Richard Hutson Sarika Munot Tim Broadhead David Nugent Georgios Theophilou Robert-Edward Jackson Diederick De Jong Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery Diagnostics epithelial ovarian cancer complete cytoreduction estimated blood loss estimated blood volume blood transfusion intra-operative mapping |
| title | Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery |
| title_full | Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery |
| title_fullStr | Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery |
| title_full_unstemmed | Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery |
| title_short | Explaining the Elusive Nature of a Well-Defined Threshold for Blood Transfusion in Advanced Epithelial Ovarian Cancer Cytoreductive Surgery |
| title_sort | explaining the elusive nature of a well defined threshold for blood transfusion in advanced epithelial ovarian cancer cytoreductive surgery |
| topic | epithelial ovarian cancer complete cytoreduction estimated blood loss estimated blood volume blood transfusion intra-operative mapping |
| url | https://www.mdpi.com/2075-4418/14/1/94 |
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