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27.03.2019 | Original Article

Development of a machine learning algorithm predicting discharge placement after surgery for spondylolisthesis

verfasst von: Paul T. Ogink, Aditya V. Karhade, Quirina C. B. S. Thio, Stuart H. Hershman, Thomas D. Cha, Christopher M. Bono, Joseph H. Schwab

Erschienen in: European Spine Journal | Ausgabe 8/2019

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Abstract

Purpose

We aimed to develop a machine learning algorithm that can accurately predict discharge placement in patients undergoing elective surgery for degenerative spondylolisthesis.

Methods

The National Surgical Quality Improvement Program (NSQIP) database was used to select patients that underwent surgical treatment for degenerative spondylolisthesis between 2009 and 2016. Our primary outcome measure was non-home discharge which was defined as any discharge not to home for which we grouped together all non-home discharge destinations including rehabilitation facility, skilled nursing facility, and unskilled nursing facility. We used Akaike information criterion to select the most appropriate model based on the outcomes of the stepwise backward logistic regression. Four machine learning algorithms were developed to predict discharge placement and were assessed by discrimination, calibration, and overall performance.

Results

Nine thousand three hundred and thirty-eight patients were included. Median age was 63 (interquartile range [IQR] 54–71), and 63% (n = 5,887) were female. The non-home discharge rate was 18.6%. Our models included age, sex, diabetes, elective surgery, BMI, procedure, number of levels, ASA class, preoperative white blood cell count, and preoperative creatinine. The Bayes point machine was considered the best model based on discrimination (AUC = 0.753), calibration (slope = 1.111; intercept = − 0.002), and overall model performance (Brier score = 0.132).

Conclusion

This study has shown that it is possible to create a predictive machine learning algorithm with both good accuracy and calibration to predict discharge placement. Using our methodology, this type of model can be developed for many other conditions and (elective) treatments.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Titel: Development of a machine learning algorithm predicting discharge placement after surgery for spondylolisthesis
verfasst von: Paul T. Ogink
Aditya V. Karhade
Quirina C. B. S. Thio
Stuart H. Hershman
Thomas D. Cha
Christopher M. Bono
Joseph H. Schwab
Publikationsdatum: 27.03.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 8/2019
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-05936-z

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Development of a machine learning algorithm predicting discharge placement after surgery for spondylolisthesis