Use of Temporally Validated Machine Learning Models To Predict Outcomes of Percutaneous Nephrolithotomy Using Data from the British Association of Urological Surgeons Percutaneous Nephrolithotomy Audit

Robert M Geraghty; Anshul Thakur; Sarah Howles; William Finch; Sarah Fowler; Alistair Rogers; Seshadri Sriprasad; Daron Smith; Andrew Dickinson; Zara Gall; Bhaskar K Somani

doi:10.1016/j.euf.2024.01.011

Use of Temporally Validated Machine Learning Models To Predict Outcomes of Percutaneous Nephrolithotomy Using Data from the British Association of Urological Surgeons Percutaneous Nephrolithotomy Audit

Eur Urol Focus. 2024 Feb 1:S2405-4569(24)00014-2. doi: 10.1016/j.euf.2024.01.011. Online ahead of print.

Authors

Affiliations

¹ Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK; Institute of Genetic Medicine, International Centre for Life, Newcastle University, Newcastle upon Tyne, UK. Electronic address: rob.geraghty@newcastle.ac.uk.
² Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
³ Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
⁴ Department of Urology, Norfolk and Norwich University Hospital, Norwich, UK.
⁵ Comparative Audit Service, Royal College of Surgeons of England, London, UK.
⁶ Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
⁷ Department of Urology, Dartford and Gravesham NHS Trust, Dartford, UK.
⁸ Institute of Urology, University College Hospital London, London, UK.
⁹ Department of Urology, University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹⁰ Department of Urology, Stockport NHS Foundation Trust, Stockport, UK.
¹¹ Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

PMID: 38307805
DOI: 10.1016/j.euf.2024.01.011

Abstract

Background and objective: Machine learning (ML) is a subset of artificial intelligence that uses data to build algorithms to predict specific outcomes. Few ML studies have examined percutaneous nephrolithotomy (PCNL) outcomes. Our objective was to build, streamline, temporally validate, and use ML models for prediction of PCNL outcomes (intensive care admission, postoperative infection, transfusion, adjuvant treatment, postoperative complications, visceral injury, and stone-free status at follow-up) using a comprehensive national database (British Association of Urological Surgeons PCNL).

Methods: This was an ML study using data from a prospective national database. Extreme gradient boosting (XGB), deep neural network (DNN), and logistic regression (LR) models were built for each outcome of interest using complete cases only, imputed, and oversampled and imputed/oversampled data sets. All validation was performed with complete cases only. Temporal validation was performed with 2019 data only. A second round used a composite of the most important 11 variables in each model to build the final model for inclusion in the shiny application. We report statistics for prognostic accuracy.

Key findings and limitations: The database contains 12 810 patients. The final variables included were age, Charlson comorbidity index, preoperative haemoglobin, Guy's stone score, stone location, size of outer sheath, preoperative midstream urine result, primary puncture site, preoperative dimercapto-succinic acid scan, stone size, and image guidance (https://endourology.shinyapps.io/PCNL_Demographics/). The areas under the receiver operating characteristic curve was >0.6 in all cases.

Conclusions and clinical implications: This is the largest ML study on PCNL outcomes to date. The models are temporally valid and therefore can be implemented in clinical practice for patient-specific risk profiling. Further work will be conducted to externally validate the models.

Patient summary: We applied artificial intelligence to data for patients who underwent a keyhole surgery to remove kidney stones and developed a model to predict outcomes for this procedure. Doctors could use this tool to advise patients about their risk of complications and the outcomes they can expect after this surgery.

Keywords: Endourology; Machine learning; Outcomes; Percutaneous nephrolithotomy; Prediction.