Predicting Prolonged Wound Drainage after Hemiarthroplasty for Hip Fractures: A Stacked Machine Learning Study

BACKGROUND: Prolonged wound drainage (PWD) is one of the most important reasons that increase the risk of early periprosthetic joint infection after arthroplasty. It is very important to evaluate the risk factors for PWD in the surgical field after arthroplasty surgery. This can be accomplished using machine learning or artificial intelligence methods. Our aim in this study was to compare machine learning methods in predicting possible PWD. METHODS: The study was carried out on clinical, laboratory, and radiological data of 313 patients who underwent hemiarthroplasty (HA) for proximal femur fractures. We preprocessed the dataset and trained and tested machine learning methods using cross validation. We compared various machine learning algorithms (linear discriminant analysis, decision tree, k-nearest neighbors, gradient boosting machine, and logistic regression [LR]) based on performance measures. We also combined the most successful algorithms with a metaclassifier. To help understand the relationship between risk factors, we provided a risk factor severity ranking. RESULTS: To estimate the risk of PWD, classification was performed with first-level classifiers and then integrated as a LR-based meta-learner stacking method. More performance improvements were achieved with the stacking method. CONCLUSIONS: We found that the stacking method was superior to other methods in PWD classification. We determined that the volume of fluid collected from the drain, morbid obesity class, blood transfusion, and body mass index score were the four most important risk factors according to stacking.