dc.contributor.author
Koenen, Lukas
dc.contributor.author
Arens, Philipp
dc.contributor.author
Olze, Heidi
dc.contributor.author
Dommerich, Steffen
dc.date.accessioned
2021-11-05T09:43:29Z
dc.date.available
2021-11-05T09:43:29Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/32574
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-32298
dc.description.abstract
Objectives: The total laryngectomy is one of the most standardized major surgical procedures in otolaryngology. Several studies have proposed the Clavien-Dindo classification (CDC) as a solution to classifying postoperative complications into 5 grades from less severe to severe. Yet more data on classifying larger patient populations undergoing major otolaryngologic surgery according to the CDC are needed. Predicting postoperative complications in clinical practice is often subject to generalized clinical scoring systems with uncertain predictive abilities for otolaryngologic surgery. Machine learning offers methods to predict postoperative complications based on data obtained prior to surgery.
Methods: We included all patients (N = 148) who underwent a total laryngectomy after diagnosis of squamous cell carcinoma at our institution. A univariate and multivariate logistic regression analysis of multiple complex risk factors was performed, and patients were grouped into severe postoperative complications (CDC >= 4) and less severe complications. Four different commonly used machine learning algorithms were trained on the dataset. The best model was selected to predict postoperative complications on the complete dataset.
Results: Univariate analysis showed that the most significant predictors for postoperative complications were the Charlson Comorbidity Index (CCI) and whether reconstruction was performed intraoperatively. A multivariate analysis showed that the CCI and reconstruction remained significant. The commonly used AdaBoost algorithm achieved the highest area under the curve with 0.77 with high positive and negative predictive values in subsequent analysis.
Conclusions: This study shows that postoperative complications can be classified according to the CDC with the CCI being a useful screening tool to predict patients at risk for postoperative complications. We provide evidence that could help identify single patients at risk for complications and customize treatment accordingly which could finally lead to a custom approach for every patient. We also suggest that there is no increase in complications with patients of higher age.
en
dc.rights.uri
https://creativecommons.org/licenses/by-nc/4.0/
dc.subject
total laryngectomy
en
dc.subject
machine learning
en
dc.subject
postoperative complications
en
dc.subject
artificial intelligence
en
dc.subject
Clavien-Dindo classification
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Classifying and Predicting Surgical Complications After Laryngectomy: A Novel Approach to Diagnosing and Treating Patients
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.doi
10.1177/01455613211029749
dcterms.bibliographicCitation.journaltitle
Ear, Nose & Throat Journal
dcterms.bibliographicCitation.originalpublishername
SAGE Publications
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
34328819
dcterms.isPartOf.eissn
1942-7522