Utilization of machine learning methods for predicting surgical outcomes after total knee arthroplasty

BACKGROUND: Predictive models could help clinicians identify risk factors that cause adverse events after total knee arthroplasty (TKA), allowing for appropriate preoperative preventive interventions and allocation of resources. METHODS: The National Inpatient Sample datasets from 2010–2014 were used to build Logistic Regression (LR), Gradient Boosting Method (GBM), Random Forest (RF), and Artificial Neural Network (ANN) predictive models for three clinically relevant outcomes after TKA—disposition at discharge, any post-surgical complications, and blood transfusion. Model performance was evaluated using the Brier scores as calibration measures, and area under the ROC curve (AUC) and F1 scores as discrimination measures. RESULTS: GBM-based predictive models were observed to have better calibration and discrimination than the other models; thus, indicating comparatively better overall performance. The Brier scores for GBM models predicting the outcomes under investigation ranged from 0.09–0.14, AUCs ranged from 79–87%, and F1-scores ranged from 41–73%. Variable importance analysis for GBM models revealed that admission month, patient location, and patient’s income level were significant predictors for all the outcomes. Additionally, any post-surgical complications and blood transfusions were significantly predicted by deficiency anemias, and discharge disposition by length of stay and age groups. Notably, any post-surgical complications were also significantly predicted by the patient undergoing blood transfusion. CONCLUSIONS: The predictive abilities of the ML models were successfully demonstrated using data from the National Inpatient Sample (NIS), indicating a wide range of clinical applications for obtaining accurate prognoses of complications following orthopedic surgical procedures.