• Changwung Jo, Sunho Ko, Woo Cheol Shin, Hyuk-Soo Han, Myung Chul Lee, Taehoon Ko, and Ro Du Hyun DH http://orcid.org/0000-0001-6199-908X Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Se.
• Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
• Knee Surg Sports Traumatol Arthrosc. 2020 Jun 1; 28 (6): 1757-1764.

PurposeA blood transfusion after total knee arthroplasty (TKA) is associated with an increase in complication and infection rates. However, no studies have been conducted to predict transfusion after TKA using a machine learning algorithm. The purpose of this study was to identify informative preoperative variables to create a machine learning model, and to provide a web-based transfusion risk-assessment system for clinical use.MethodsThis study retrospectively reviewed 1686 patients who underwent TKA at our institution. Data for 43 preoperative variables, including medication history, laboratory values, and demographic characteristics, were collected. Variable selection was conducted using the recursive feature elimination algorithm. The transfusion group was defined as patients with haemoglobin (Hb) < 7 g/dL after TKA. A predictive model was developed using the gradient boosting machine, and the performance of the model was assessed by the area under the receiver operating characteristic curve (AUC). Data sets from an independent institution were tested with the model for external validation.ResultsOf the 1686 patients who underwent TKA, 108 (6.4%) were categorized into the transfusion group. Six preoperative variables were selected, including preoperative Hb, platelet count, type of surgery, tranexamic acid, age, and body weight. The predictive model demonstrated good predictive performance using the six variables [AUC 0.842; 95% confidence interval (CI) 0.820-0.856]. Performance was also good according to the external validation using 400 data from an independent institution (AUC 0.880; 95% CI 0.844-0.910). This web-based blood transfusion risk-assessment system can be accessed at http://safetka.net.ConclusionsA web-based predictive model for transfusion after TKA using a machine learning algorithm was developed using six preoperative variables. The model is simple, has been validated, showed good performance, and can be used before TKA to predict the risk of transfusion and guide appropriate precautions for high-risk patients.Level Of EvidenceDiagnostic level II.

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