Reliable Prediction of Discharge Disposition Following Cervical Spine Surgery With Ensemble Machine Learning and Validation on a National Cohort.

Autor:	Feng R; Departments of Neurosurgery., Valliani AA; Departments of Neurosurgery., Martini ML; Departments of Neurosurgery., Gal JS; Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai., Neifert SN; Department of Neurosurgery, New York University Langone Medical Center., Kim NC; Department of Neurosurgery, New York University Langone Medical Center., Geng EA; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai., Kim JS; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai., Cho SK; Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai., Oermann EK; Department of Neurosurgery, New York University Langone Medical Center.; Department of Radiology, New York University Langone Medical Center.; Center for Data Science, New York University Langone Medical Center, New York, NY., Caridi JM; Department of Neurosurgery, University of Texas Health Science Center, Houston, TX.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2024 Feb 01; Vol. 37 (1), pp. E30-E36. Date of Electronic Publication: 2024 Jan 29.
DOI:	10.1097/BSD.0000000000001520
Abstrakt:	Study Design: A retrospective cohort study. Objective: The purpose of this study is to develop a machine learning algorithm to predict nonhome discharge after cervical spine surgery that is validated and usable on a national scale to ensure generalizability and elucidate candidate drivers for prediction. Summary of Background Data: Excessive length of hospital stay can be attributed to delays in postoperative referrals to intermediate care rehabilitation centers or skilled nursing facilities. Accurate preoperative prediction of patients who may require access to these resources can facilitate a more efficient referral and discharge process, thereby reducing hospital and patient costs in addition to minimizing the risk of hospital-acquired complications. Methods: Electronic medical records were retrospectively reviewed from a single-center data warehouse (SCDW) to identify patients undergoing cervical spine surgeries between 2008 and 2019 for machine learning algorithm development and internal validation. The National Inpatient Sample (NIS) database was queried to identify cervical spine fusion surgeries between 2009 and 2017 for external validation of algorithm performance. Gradient-boosted trees were constructed to predict nonhome discharge across patient cohorts. The area under the receiver operating characteristic curve (AUROC) was used to measure model performance. SHAP values were used to identify nonlinear risk factors for nonhome discharge and to interpret algorithm predictions. Results: A total of 3523 cases of cervical spine fusion surgeries were included from the SCDW data set, and 311,582 cases were isolated from NIS. The model demonstrated robust prediction of nonhome discharge across all cohorts, achieving an area under the receiver operating characteristic curve of 0.87 (SD=0.01) on both the SCDW and nationwide NIS test sets. Anterior approach only, age, elective admission status, Medicare insurance status, and total Elixhauser Comorbidity Index score were the most important predictors of discharge destination. Conclusions: Machine learning algorithms reliably predict nonhome discharge across single-center and national cohorts and identify preoperative features of importance following cervical spine fusion surgery. Competing Interests: The authors declare no conflict of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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