Ensemble learning-assisted prediction of prolonged hospital length of stay after spine correction surgery: a multi-center cohort study

Wenle Li; Yusi Zhang; Xin Zhou; Xubin Quan; Binghao Chen; Xuewen Hou; Qizhong Xu; Weiheng He; Liang Chen; Xiaozhu Liu; Yang Zhang; Tianyu Xiang; Runmin Li; Qiang Liu; Shi-Nan Wu; Kai Wang; Wencai Liu; Jialiang Zheng; Haopeng Luan; Xiaolin Yu; Anfa Chen; Chan Xu; Tongqing Luo; Zhaohui Hu

doi:10.1186/s13018-024-04576-4

Ensemble learning-assisted prediction of prolonged hospital length of stay after spine correction surgery: a multi-center cohort study

J Orthop Surg Res. 2024 Feb 2;19(1):112. doi: 10.1186/s13018-024-04576-4.

Authors

Wenle Li^#^{1

2

3}, Yusi Zhang^#^{4

5

6}, Xin Zhou^#⁷, Xubin Quan⁸, Binghao Chen⁸, Xuewen Hou⁹, Qizhong Xu¹⁰, Weiheng He¹¹, Liang Chen¹², Xiaozhu Liu^{13

14}, Yang Zhang^{15

16}, Tianyu Xiang¹⁷, Runmin Li¹⁸, Qiang Liu¹⁹, Shi-Nan Wu²⁰, Kai Wang²¹, Wencai Liu²², Jialiang Zheng²³, Haopeng Luan²⁴, Xiaolin Yu²⁵, Anfa Chen²⁶, Chan Xu²⁷, Tongqing Luo²⁸, Zhaohui Hu²⁹

Affiliations

¹ State Key Laboratory of Molecular Vaccinology and Molecular, Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China. drlee0910@163.com.
² Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China. drlee0910@163.com.
³ Department of Spinal Surgery, Guangxi Medical University Affiliated Liuzhou People's Hospital, Liuzhou, China. drlee0910@163.com.
⁴ Cancer Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁵ Precision Medicine Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁶ Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁷ Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
⁸ Department of Spinal Surgery, Guangxi Medical University Affiliated Liuzhou People's Hospital, Liuzhou, China.
⁹ Department of Radiology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China.
¹⁰ Department of Radiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China.
¹¹ Department of Radiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China.
¹² Department of Radiology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
¹³ Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
¹⁴ Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁵ College of Medical Informatics, Chongqing Medical University, Chongqing, China.
¹⁶ Medical Data Science Academy, Chongqing Medical University, Chongqing, China.
¹⁷ Information Center, The University-Town Hospital of Chongqing Medical University, Chongqing, China.
¹⁸ Department of Foot and Ankle Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
¹⁹ Department of Orthopedics, Xianyang Central Hospital, Xianyang, Shannxi, China.
²⁰ Eye Institute of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
²¹ Key Laboratory of Neurological Diseases, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
²² Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
²³ Cancer Research Center, School of Medicine, Xiamen University, Xiamen, China.
²⁴ Department of Spine Surgery, The Six Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
²⁵ Department of Orthopedics, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
²⁶ Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, China.
²⁷ State Key Laboratory of Molecular Vaccinology and Molecular, Diagnostics and Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China.
²⁸ Department of Spinal Surgery, Guangxi Medical University Affiliated Liuzhou People's Hospital, Liuzhou, China. luotongqing2929@sina.com.
²⁹ Department of Spinal Surgery, Guangxi Medical University Affiliated Liuzhou People's Hospital, Liuzhou, China. 329870376@qq.com.

^# Contributed equally.

Abstract

Purpose: This research aimed to develop a machine learning model to predict the potential risk of prolonged length of stay in hospital before operation, which can be used to strengthen patient management.

Methods: Patients who underwent posterior spinal deformity surgery (PSDS) from eleven medical institutions in China between 2015 and 2022 were included. Detailed preoperative patient data, including demographics, medical history, comorbidities, preoperative laboratory results, and surgery details, were collected from their electronic medical records. The cohort was randomly divided into a training dataset and a validation dataset with a ratio of 70:30. Based on Boruta algorithm, nine different machine learning algorithms and a stack ensemble model were trained after hyperparameters tuning visualization and evaluated on the area under the receiver operating characteristic curve (AUROC), precision-recall curve, calibration, and decision curve analysis. Visualization of Shapley Additive exPlanations method finally contributed to explaining model prediction.

Results: Of the 162 included patients, the K Nearest Neighbors algorithm performed the best in the validation group compared with other machine learning models (yielding an AUROC of 0.8191 and PRAUC of 0.6175). The top five contributing variables were the preoperative hemoglobin, height, body mass index, age, and preoperative white blood cells. A web-based calculator was further developed to improve the predictive model's clinical operability.

Conclusions: Our study established and validated a clinical predictive model for prolonged postoperative hospitalization duration in patients who underwent PSDS, which offered valuable prognostic information for preoperative planning and postoperative care for clinicians. Trial registration ClinicalTrials.gov identifier NCT05867732, retrospectively registered May 22, 2023, https://classic.

Clinicaltrials: gov/ct2/show/NCT05867732 .

Keywords: Machine learning; Multimodal; Posterior spinal deformity surgery; Postoperative length of stay; Spinal deformity.

Publication types

Clinical Study
Multicenter Study

MeSH terms

Algorithms*
Cohort Studies
Hospitals*
Humans
Length of Stay
Machine Learning

Associated data

ClinicalTrials.gov/NCT05867732

Abstract

Publication types

MeSH terms

Associated data

Grants and funding