Predicting extended hospital stay following revision total hip arthroplasty: a machine learning model analysis based on the ACS-NSQIP database.

Autor: Chen TL; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.; Department of Biomedical Engineering, The Hong Kong Polytechnic University, Yuk Choi Rd 11, 999077, Hong Kong SAR, China., RezazadehSaatlou M; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA., Buddhiraju A; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA., Seo HH; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA., Shimizu MR; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA., Kwon YM; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA. ymkwon@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Sep 19. Date of Electronic Publication: 2024 Sep 19.
DOI: 10.1007/s00402-024-05542-9
Abstrakt: Introduction: Prolonged length of stay (LOS) following revision total hip arthroplasty (THA) can lead to increased healthcare costs, higher rates of readmission, and lower patient satisfaction. In this study, we investigated the predictive power of machine learning (ML) models for prolonged LOS after revision THA using patient data from a national-scale patient repository.
Materials and Methods: We identified 11,737 revision THA cases from the American College of Surgeons National Surgical Quality Improvement Program database from 2013 to 2020. Prolonged LOS was defined as exceeding the 75th value of all LOSs in the study cohort. We developed four ML models: artificial neural network (ANN), random forest, histogram-based gradient boosting, and k-nearest neighbor, to predict prolonged LOS after revision THA. Each model's performance was assessed during training and testing sessions in terms of discrimination, calibration, and clinical utility.
Results: The ANN model was the most accurate with an AUC of 0.82, calibration slope of 0.90, calibration intercept of 0.02, and Brier score of 0.140 during testing, indicating the model's competency in distinguishing patients subject to prolonged LOS with minimal prediction error. All models showed clinical utility by producing net benefits in the decision curve analyses. The most significant predictors of prolonged LOS were preoperative blood tests (hematocrit, platelet count, and leukocyte count), preoperative transfusion, operation time, indications for revision THA (infection), and age.
Conclusions: Our study demonstrated that the ML model accurately predicted prolonged LOS after revision THA. The results highlighted the importance of the indications for revision surgery in determining the risk of prolonged LOS. With the model's aid, clinicians can stratify individual patients based on key factors, improve care coordination and discharge planning for those at risk of prolonged LOS, and increase cost efficiency.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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