Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort?

Geubbels, Noëlle; Brauw, L. M. de; Acherman, Yaïr I. Z.; Laar, Arnold van de; Bruin, Sjoerd C.

doi:10.1007/s11695-015-1699-2

Cited by 27 publications

(14 citation statements)

References 48 publications

(29 reference statements)

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“…Although no association between beta-blockade and serious postoperative complications was detected in the present study, increasing age, lower BMI, and lower disposable income were all associated with increased risk for such adverse events. While age is a well-known risk factor for postoperative complications after bariatric surgery [3,[22][23][24], BMI has been reported to be a poor predictor [3,22]. However, previous studies have reported a tendency towards higher risk for patients with extreme BMI values, both low and high [3,25,26].…”

Section: Discussionmentioning

confidence: 99%

Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery

et al. 2019

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Background The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. Methods Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. Results In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). Conclusions Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.

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Section: Discussionmentioning

confidence: 99%

Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery

et al. 2019

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“…These models could also serve as the basis for case-mix comparisons between different centers. Some prediction models that are based on the linear regression of patient-specific data allow for relatively simple and interpretable inference; however, so far they have been proven inaccurate and thus cannot be used in clinical practice [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery

Cao

Fang

Ottosson

et al. 2019

JCM

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Background: Severe obesity is a global public health threat of growing proportions. Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. So far, traditional statistical methods have failed to produce high accuracy. We aimed to find a useful machine learning (ML) algorithm to predict the risk for severe complication after bariatric surgery. Methods: We trained and compared 29 supervised ML algorithms using information from 37,811 patients that operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6250 patients operated in 2015. We performed the synthetic minority oversampling technique tackling the issue that only 3% of patients experienced severe complications. Results: Most of the ML algorithms showed high accuracy (>90%) and specificity (>90%) in both the training and test data. However, none of the algorithms achieved an acceptable sensitivity in the test data. We also tried to tune the hyperparameters of the algorithms to maximize sensitivity, but did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. However, a minor, but perceptible, improvement in deep neural network (NN) ML was found. Conclusion: In predicting the severe postoperative complication among the bariatric surgery patients, ensemble algorithms outperform base algorithms. When compared to other ML algorithms, deep NN has the potential to improve the accuracy and it deserves further investigation. The oversampling technique should be considered in the context of imbalanced data where the number of the interested outcome is relatively small.

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“…In this way, the external validity of the RCT could be evaluated. Even though patients in the RCT had a slightly lower prevalence of associated co‐morbidity than those in in the non‐RCT group, the RCT cohort reflects the population of individuals having bariatric surgery throughout Europe. The RCT was conducted in a register setting, offering the potential for quick enrolment of patients and broad generalizability of the results.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database

Stenberg

Szabó

Ottosson

et al. 2017

British Journal of Surgery

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Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort?

Cited by 27 publications

References 48 publications

Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery

Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery

A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery

Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database

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