Machine learning for identification of surgeries with high risks of cancellation

Surgery cancellations waste scarce operative resources and hinder patients’ access to operative services. In this study, the Wilcoxon and chi-square tests were used for predictor selection, and three machine learning models – random forest, support vector machine, and XGBoost – were used for the identification of surgeries with high risks of cancellation. The optimal performances of the identification models were as follows: sensitivity − 0.615; specificity − 0.957; positive predictive value − 0.454; negative predictive value − 0.904; accuracy − 0.647; and area under the receiver operating characteristic curve − 0.682. Of the three models, the random forest model achieved the best performance. Thus, the effective identification of surgeries with high risks of cancellation is feasible with stable performance. Models and sampling methods significantly affect the performance of identification. This study is a new application of machine learning for the identification of surgeries with high risks of cancellation and facilitation of surgery resource management.

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Premio de Investigación SCHOT 2020: desarrollo y validación de un modelo multivariables de predicción de estadía hospitalaria en pacientes mayores de 65 años sometidos artroplastia total de cadera electiva en Chile utilizando aprendizaje de máquinas

Revista Chilena de Ortopedia y Traumatología ◽

10.1055/s-0041-1740232 ◽

2021 ◽

Vol 62 (03) ◽

pp. e180-e192

Author(s):

Claudio Díaz-Ledezma ◽

David Díaz-Solís ◽

Raúl Muñoz-Reyes ◽

Jonathan Torres Castro

Keyword(s):

Machine Learning ◽

Support Vector Machine ◽

Big Data ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Support Vector ◽

Operating Characteristic Curve ◽

Receiver Operating

Resumen Introducción La predicción de la estadía hospitalaria luego de una artroplastia total de cadera (ATC) electiva es crucial en la evaluación perioperatoria de los pacientes, con un rol determinante desde el punto de vista operacional y económico. Internacionalmente, se han empleado macrodatos (big data, en inglés) e inteligencia artificial para llevar a cabo evaluaciones pronósticas de este tipo. El objetivo del presente estudio es desarrollar y validar, con el empleo del aprendizaje de máquinas (machine learning, en inglés), una herramienta capaz de predecir la estadía hospitalaria de pacientes chilenos mayores de 65 años sometidos a ATC por artrosis. Material y Métodos Empleando los registros electrónicos de egresos hospitalarios anonimizados del Departamento de Estadísticas e Información de Salud (DEIS), se obtuvieron los datos de 8.970 egresos hospitalarios de pacientes sometidos a ATC por artrosis entre los años 2016 y 2018. En total, 15 variables disponibles en el DEIS, además del porcentaje de pobreza de la comuna de origen del paciente, fueron incluidos para predecir la probabilidad de que un paciente presentara una estadía acortada (< 3 días) o prolongada (> 3 días) luego de la cirugía. Utilizando técnicas de aprendizaje de máquinas, 8 algoritmos de predicción fueron entrenados con el 80% de la muestra. El 20% restante se empleó para validar las capacidades predictivas de los modelos creados a partir de los algoritmos. La métrica de optimización se evaluó y ordenó en un ranking utilizando el área bajo la curva de característica operativa del receptor (area under the receiver operating characteristic curve, AUC-ROC, en inglés), que corresponde a cuan bien un modelo puede distinguir entre dos grupos. Resultados El algoritmo XGBoost obtuvo el mejor desempeño, con una AUC-ROC promedio de 0,86 (desviación estándar [DE]: 0,0087). En segundo lugar, observamos que el algoritmo lineal de máquina de vector de soporte (support vector machine, SVM, en inglés) obtuvo una AUC-ROC de 0,85 (DE: 0,0086). La importancia relativa de las variables explicativas demostró que la región de residencia, el servicio de salud, el establecimiento de salud donde se operó el paciente, y la modalidad de atención son las variables que más determinan el tiempo de estadía de un paciente. Discusión El presente estudio desarrolló algoritmos de aprendizaje de máquinas basados en macrodatos chilenos de libre acceso, y logró desarrollar y validar una herramienta que demuestra una adecuada capacidad discriminatoria para predecir la probabilidad de estadía hospitalaria acortada versus prolongada en adultos mayores sometidos a ATC por artrosis. Conclusión Los algoritmos creados a traves del empleo del aprendizaje de máquinas permiten predecir la estadía hospitalaria en pacientes chilenos operado de artroplastia total de cadera electiva.

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Using The Random Forest Algorithm To Detect The Activity of Thyroid-Associated Ophthalmopathy

10.21203/rs.3.rs-787674/v1 ◽

2021 ◽

Author(s):

Minghui Wang ◽

Hanqiao Zhang ◽

Li Dong ◽

Yang Li ◽

Zhijia Hou ◽

...

Keyword(s):

Random Forest ◽

Predictive Value ◽

Diagnostic Performance ◽

Operating Characteristic ◽

Characteristic Curve ◽

Random Forest Model ◽

Random Forest Algorithm ◽

Forest Model ◽

Thyroid Associated Ophthalmopathy ◽

Operating Characteristic Curve

Abstract Objective: The aim of this study is to establish a random forest model to detect active and quiescent phases of patients with Thyroid-associated ophthalmopathy (TAO) and to evaluate its diagnostic performance.Methods：A total of 146 patients (292 eyes) who were diagnosed with TAO and were treated in the Ophthalmology Outpatient Clinic of Beijing TongRen hospital were retrospectively included in the study. We took the clinical activity score of TAO as the target; took gender, age, smoking status, I-131 treatment history, thyroid nodules, thyromegaly, thyroid hormone and TSH-receptor antibodies (TRAb) as predictive characteristic variables to establish a random forest model. The proportion of the training group to the testing group was 7:3. We analyzed the model’s accuracy, precision, sensitivity, specificity, positive predictive value (PPV), negative predictive value (PPV), F1 score and out-of-bag (OOB) error, with the accuracy, the brier loss and the area under the receiver operating characteristic curve compared with logistic regression model.Results：Our model has an accuracy of 0.93, a sensitivity of 0.88, a specificity of 0.96, a positive predictive value of 0.94, a negative predictive value of 0.93, an F1 score of 0.91 and an OOB error of 0.12. The accuracy of the random forest model and the logistic regression model were 0.93 and 0.79, respectively, the brier loss were 0.06 and 0.20, and the area under the receiver operating characteristic curve were 0.95 and 0.86.Conclusion：By integrating these high-risk factors, the random forest algorithm can be used as a complementary diagnostic method to determine the activity of TAO, showing prominent diagnostic performance.

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Application of Machine Learning for Predicting Anastomotic Leakage in Patients with Gastric Adenocarcinoma Who Received Total or Proximal Gastrectomy

Journal of Personalized Medicine ◽

10.3390/jpm11080748 ◽

2021 ◽

Vol 11 (8) ◽

pp. 748

Author(s):

Shengli Shao ◽

Lu Liu ◽

Yufeng Zhao ◽

Lei Mu ◽

Qiyi Lu ◽

...

Keyword(s):

Machine Learning ◽

Random Forest ◽

Anastomotic Leakage ◽

Gastric Adenocarcinoma ◽

Predictive Value ◽

High Performance ◽

Characteristic Curve ◽

Proximal Gastrectomy ◽

Support Vector ◽

Sensitivity Specificity

Anastomotic leakage is a life-threatening complication in patients with gastric adenocarcinoma who received total or proximal gastrectomy, and there is still no model accurately predicting anastomotic leakage. In this study, we aim to develop a high-performance machine learning tool to predict anastomotic leakage in patients with gastric adenocarcinoma received total or proximal gastrectomy. A total of 1660 cases of gastric adenocarcinoma patients who received total or proximal gastrectomy in a large academic hospital from 1 January 2010 to 31 December 2019 were investigated, and these patients were randomly divided into training and testing sets at a ratio of 8:2. Four machine learning models, such as logistic regression, random forest, support vector machine, and XGBoost, were employed, and 24 clinical preoperative and intraoperative variables were included to develop the predictive model. Regarding the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, random forest had a favorable performance with an AUC of 0.89, a sensitivity of 81.8% and specificity of 82.2% in the testing set. Moreover, we built a web app based on random forest model to achieve real-time predictions for guiding surgeons’ intraoperative decision making.

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Can machine learning improve mortality prediction following cardiac surgery?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa229 ◽

2020 ◽

Vol 58 (6) ◽

pp. 1130-1136

Author(s):

Umberto Benedetto ◽

Shubhra Sinha ◽

Matt Lyon ◽

Arnaldo Dimagli ◽

Tom R Gaunt ◽

...

Keyword(s):

Machine Learning ◽

Cardiac Surgery ◽

Random Forest ◽

Hospital Mortality ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Operating Characteristic Curve ◽

Receiver Operating

Abstract OBJECTIVES Interest in the clinical usefulness of machine learning for risk prediction has bloomed recently. Cardiac surgery patients are at high risk of complications and therefore presurgical risk assessment is of crucial relevance. We aimed to compare the performance of machine learning algorithms over traditional logistic regression (LR) model to predict in-hospital mortality following cardiac surgery. METHODS A single-centre data set of prospectively collected information from patients undergoing adult cardiac surgery from 1996 to 2017 was split into 70% training set and 30% testing set. Prediction models were developed using neural network, random forest, naive Bayes and retrained LR based on features included in the EuroSCORE. Discrimination was assessed using area under the receiver operating characteristic curve, and calibration analysis was undertaken using the calibration belt method. Model calibration drift was assessed by comparing Goodness of fit χ2 statistics observed in 2 equal bins from the testing sample ordered by procedure date. RESULTS A total of 28 761 cardiac procedures were performed during the study period. The in-hospital mortality rate was 2.7%. Retrained LR [area under the receiver operating characteristic curve 0.80; 95% confidence interval (CI) 0.77–0.83] and random forest model (0.80; 95% CI 0.76–0.83) showed the best discrimination. All models showed significant miscalibration. Retrained LR proved to have the weakest calibration drift. CONCLUSIONS Our findings do not support the hypothesis that machine learning methods provide advantage over LR model in predicting operative mortality after cardiac surgery.

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Machine learning applications for the prediction of surgical site infection in neurological operations

Neurosurgical FOCUS ◽

10.3171/2019.5.focus19241 ◽

2019 ◽

Vol 47 (2) ◽

pp. E7 ◽

Cited By ~ 2

Author(s):

Thara Tunthanathip ◽

Sakchai Sae-heng ◽

Thakul Oearsakul ◽

Ittichai Sakarunchai ◽

Anukoon Kaewborisutsakul ◽

...

Keyword(s):

Machine Learning ◽

Surgical Site Infection ◽

Receiver Operating Characteristic Curve ◽

Predictive Value ◽

Operating Characteristic ◽

Naive Bayes ◽

Characteristic Curve ◽

Naïve Bayes ◽

Site Infection ◽

Operating Characteristic Curve

OBJECTIVESurgical site infection (SSI) following a neurosurgical operation is a complication that impacts morbidity, mortality, and economics. Currently, machine learning (ML) algorithms are used for outcome prediction in various neurosurgical aspects. The implementation of ML algorithms to learn from medical data may help in obtaining prognostic information on diseases, especially SSIs. The purpose of this study was to compare the performance of various ML models for predicting surgical infection after neurosurgical operations.METHODSA retrospective cohort study was conducted on patients who had undergone neurosurgical operations at tertiary care hospitals between 2010 and 2017. Supervised ML algorithms, which included decision tree, naive Bayes with Laplace correction, k-nearest neighbors, and artificial neural networks, were trained and tested as binary classifiers (infection or no infection). To evaluate the ML models from the testing data set, their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as their accuracy, receiver operating characteristic curve, and area under the receiver operating characteristic curve (AUC) were analyzed.RESULTSData were available for 1471 patients in the study period. The SSI rate was 4.6%, and the type of SSI was superficial, deep, and organ/space in 1.2%, 0.8%, and 2.6% of cases, respectively. Using the backward stepwise method, the authors determined that the significant predictors of SSI in the multivariable Cox regression analysis were postoperative CSF leakage/subgaleal collection (HR 4.24, p < 0.001) and postoperative fever (HR 1.67, p = 0.04). Compared with other ML algorithms, the naive Bayes had the highest performance with sensitivity at 63%, specificity at 87%, PPV at 29%, NPV at 96%, and AUC at 76%.CONCLUSIONSThe naive Bayes algorithm is highlighted as an accurate ML method for predicting SSI after neurosurgical operations because of its reasonable accuracy. Thus, it can be used to effectively predict SSI in individual neurosurgical patients. Therefore, close monitoring and allocation of treatment strategies can be informed by ML predictions in general practice.

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Predicting Risk of Antenatal Depression and Anxiety Using Multi-Layer Perceptrons and Support Vector Machines

Journal of Personalized Medicine ◽

10.3390/jpm11030199 ◽

2021 ◽

Vol 11 (3) ◽

pp. 199

Author(s):

Fajar Javed ◽

Syed Omer Gilani ◽

Seemab Latif ◽

Asim Waris ◽

Mohsin Jamil ◽

...

Keyword(s):

Low Income ◽

Operating Characteristic ◽

Mental Health Problems ◽

Characteristic Curve ◽

Antenatal Depression ◽

Low Income Countries ◽

Support Vector ◽

Depression And Anxiety ◽

Gynecology And Obstetrics ◽

Operating Characteristic Curve

Perinatal depression and anxiety are defined to be the mental health problems a woman faces during pregnancy, around childbirth, and after child delivery. While this often occurs in women and affects all family members including the infant, it can easily go undetected and underdiagnosed. The prevalence rates of antenatal depression and anxiety worldwide, especially in low-income countries, are extremely high. The wide majority suffers from mild to moderate depression with the risk of leading to impaired child–mother relationship and infant health, few women end up taking their own lives. Owing to high costs and non-availability of resources, it is almost impossible to diagnose every pregnant woman for depression/anxiety whereas under-detection can have a lasting impact on mother and child’s health. This work proposes a multi-layer perceptron based neural network (MLP-NN) classifier to predict the risk of depression and anxiety in pregnant women. We trained and evaluated our proposed system on a Pakistani dataset of 500 women in their antenatal period. ReliefF was used for feature selection before classifier training. Evaluation metrics such as accuracy, sensitivity, specificity, precision, F1 score, and area under the receiver operating characteristic curve were used to evaluate the performance of the trained model. Multilayer perceptron and support vector classifier achieved an area under the receiving operating characteristic curve of 88% and 80% for antenatal depression and 85% and 77% for antenatal anxiety, respectively. The system can be used as a facilitator for screening women during their routine visits in the hospital’s gynecology and obstetrics departments.

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Machine Learning-based in-hospital Mortality Prediction Models for Patients With Acute Coronary Syndrome

10.21203/rs.3.rs-134944/v1 ◽

2020 ◽

Author(s):

Jun Ke ◽

Yiwei Chen ◽

Xiaoping Wang ◽

Zhiyong Wu ◽

qiongyao Zhang ◽

...

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Random Forest ◽

Hospital Mortality ◽

Operating Characteristic ◽

Prediction Models ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Hdl Cholesterol ◽

Coronary Syndrome

Abstract BackgroundThe purpose of this study is to identify the risk factors of in-hospital mortality in patients with acute coronary syndrome (ACS) and to evaluate the performance of traditional regression and machine learning prediction models.MethodsThe data of ACS patients who entered the emergency department of Fujian Provincial Hospital from January 1, 2017 to March 31, 2020 for chest pain were retrospectively collected. The study used univariate and multivariate logistic regression analysis to identify risk factors for in-hospital mortality of ACS patients. The traditional regression and machine learning algorithms were used to develop predictive models, and the sensitivity, specificity, and receiver operating characteristic curve were used to evaluate the performance of each model.ResultsA total of 7810 ACS patients were included in the study, and the in-hospital mortality rate was 1.75%. Multivariate logistic regression analysis found that age and levels of D-dimer, cardiac troponin I, N-terminal pro-B-type natriuretic peptide (NT-proBNP), lactate dehydrogenase (LDH), high-density lipoprotein (HDL) cholesterol, and calcium channel blockers were independent predictors of in-hospital mortality. The study found that the area under the receiver operating characteristic curve of the models developed by logistic regression, gradient boosting decision tree (GBDT), random forest, and support vector machine (SVM) for predicting the risk of in-hospital mortality were 0.963, 0.960, 0.963, and 0.959, respectively. Feature importance evaluation found that NT-proBNP, LDH, and HDL cholesterol were top three variables that contribute the most to the prediction performance of the GBDT model and random forest model.ConclusionsThe predictive model developed using logistic regression, GBDT, random forest, and SVM algorithms can be used to predict the risk of in-hospital death of ACS patients. Based on our findings, we recommend that clinicians focus on monitoring the changes of NT-proBNP, LDH, and HDL cholesterol, as this may improve the clinical outcomes of ACS patients.

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A Time-Updated, Parsimonious Model to Predict AKI in Hospitalized Children

Journal of the American Society of Nephrology ◽

10.1681/asn.2019070745 ◽

2020 ◽

Vol 31 (6) ◽

pp. 1348-1357 ◽

Cited By ~ 1

Author(s):

Ibrahim Sandokji ◽

Yu Yamamoto ◽

Aditya Biswas ◽

Tanima Arora ◽

Ugochukwu Ugwuowo ◽

...

Keyword(s):

Machine Learning ◽

Prediction Model ◽

Receiver Operating Characteristic Curve ◽

Operating Characteristic ◽

Characteristic Curve ◽

External Validation ◽

Health Record ◽

Hospitalized Children ◽

Operating Characteristic Curve ◽

Electronic Health

BackgroundTimely prediction of AKI in children can allow for targeted interventions, but the wealth of data in the electronic health record poses unique modeling challenges.MethodsWe retrospectively reviewed the electronic medical records of all children younger than 18 years old who had at least two creatinine values measured during a hospital admission from January 2014 through January 2018. We divided the study population into derivation, and internal and external validation cohorts, and used five feature selection techniques to select 10 of 720 potentially predictive variables from the electronic health records. Model performance was assessed by the area under the receiver operating characteristic curve in the validation cohorts. The primary outcome was development of AKI (per the Kidney Disease Improving Global Outcomes creatinine definition) within a moving 48-hour window. Secondary outcomes included severe AKI (stage 2 or 3), inpatient mortality, and length of stay.ResultsAmong 8473 encounters studied, AKI occurred in 516 (10.2%), 207 (9%), and 27 (2.5%) encounters in the derivation, and internal and external validation cohorts, respectively. The highest-performing model used a machine learning-based genetic algorithm, with an overall receiver operating characteristic curve in the internal validation cohort of 0.76 [95% confidence interval (CI), 0.72 to 0.79] for AKI, 0.79 (95% CI, 0.74 to 0.83) for severe AKI, and 0.81 (95% CI, 0.77 to 0.86) for neonatal AKI. To translate this prediction model into a clinical risk-stratification tool, we identified high- and low-risk threshold points.ConclusionsUsing various machine learning algorithms, we identified and validated a time-updated prediction model of ten readily available electronic health record variables to accurately predict imminent AKI in hospitalized children.

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A Framework for Effective Application of Machine Learning to Microbiome-Based Classification Problems

mBio ◽

10.1128/mbio.00434-20 ◽

2020 ◽

Vol 11 (3) ◽

Cited By ~ 9

Author(s):

Begüm D. Topçuoğlu ◽

Nicholas A. Lesniak ◽

Mack T. Ruffin ◽

Jenna Wiens ◽

Patrick D. Schloss

Keyword(s):

Machine Learning ◽

Logistic Regression ◽

Random Forest ◽

Sequence Data ◽

Characteristic Curve ◽

Predictive Performance ◽

Model Complexity ◽

Support Vector ◽

Classification Problems ◽

Microbial Biomarkers

ABSTRACT Machine learning (ML) modeling of the human microbiome has the potential to identify microbial biomarkers and aid in the diagnosis of many diseases such as inflammatory bowel disease, diabetes, and colorectal cancer. Progress has been made toward developing ML models that predict health outcomes using bacterial abundances, but inconsistent adoption of training and evaluation methods call the validity of these models into question. Furthermore, there appears to be a preference by many researchers to favor increased model complexity over interpretability. To overcome these challenges, we trained seven models that used fecal 16S rRNA sequence data to predict the presence of colonic screen relevant neoplasias (SRNs) (n = 490 patients, 261 controls and 229 cases). We developed a reusable open-source pipeline to train, validate, and interpret ML models. To show the effect of model selection, we assessed the predictive performance, interpretability, and training time of L2-regularized logistic regression, L1- and L2-regularized support vector machines (SVM) with linear and radial basis function kernels, a decision tree, random forest, and gradient boosted trees (XGBoost). The random forest model performed best at detecting SRNs with an area under the receiver operating characteristic curve (AUROC) of 0.695 (interquartile range [IQR], 0.651 to 0.739) but was slow to train (83.2 h) and not inherently interpretable. Despite its simplicity, L2-regularized logistic regression followed random forest in predictive performance with an AUROC of 0.680 (IQR, 0.625 to 0.735), trained faster (12 min), and was inherently interpretable. Our analysis highlights the importance of choosing an ML approach based on the goal of the study, as the choice will inform expectations of performance and interpretability. IMPORTANCE Diagnosing diseases using machine learning (ML) is rapidly being adopted in microbiome studies. However, the estimated performance associated with these models is likely overoptimistic. Moreover, there is a trend toward using black box models without a discussion of the difficulty of interpreting such models when trying to identify microbial biomarkers of disease. This work represents a step toward developing more-reproducible ML practices in applying ML to microbiome research. We implement a rigorous pipeline and emphasize the importance of selecting ML models that reflect the goal of the study. These concepts are not particular to the study of human health but can also be applied to environmental microbiology studies.

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Machine-Learning and Stochastic Tumor Growth Models for Predicting Outcomes in Patients With Advanced Non–Small-Cell Lung Cancer

JCO Clinical Cancer Informatics ◽

10.1200/cci.19.00046 ◽

2019 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Kien Wei Siah ◽

Sean Khozin ◽

Chi Heem Wong ◽

Andrew W. Lo

Keyword(s):

Machine Learning ◽

Lung Cancer ◽

Clinical Trials ◽

Operating Characteristic ◽

Advanced Nsclc ◽

Characteristic Curve ◽

Small Cell ◽

Small Cell Lung ◽

Out Of Sample ◽

Operating Characteristic Curve

PURPOSE The prediction of clinical outcomes for patients with cancer is central to precision medicine and the design of clinical trials. We developed and validated machine-learning models for three important clinical end points in patients with advanced non–small-cell lung cancer (NSCLC)—objective response (OR), progression-free survival (PFS), and overall survival (OS)—using routinely collected patient and disease variables. METHODS We aggregated patient-level data from 17 randomized clinical trials recently submitted to the US Food and Drug Administration evaluating molecularly targeted therapy and immunotherapy in patients with advanced NSCLC. To our knowledge, this is one of the largest studies of NSCLC to consider biomarker and inhibitor therapy as candidate predictive variables. We developed a stochastic tumor growth model to predict tumor response and explored the performance of a range of machine-learning algorithms and survival models. Models were evaluated on out-of-sample data using the standard area under the receiver operating characteristic curve and concordance index (C-index) performance metrics. RESULTS Our models achieved promising out-of-sample predictive performances of 0.79 area under the receiver operating characteristic curve (95% CI, 0.77 to 0.81), 0.67 C-index (95% CI, 0.66 to 0.69), and 0.73 C-index (95% CI, 0.72 to 0.74) for OR, PFS, and OS, respectively. The calibration plots for PFS and OS suggested good agreement between actual and predicted survival probabilities. In addition, the Kaplan-Meier survival curves showed that the difference in survival between the low- and high-risk groups was significant (log-rank test P < .001) for both PFS and OS. CONCLUSION Biomarker status was the strongest predictor of OR, PFS, and OS in patients with advanced NSCLC treated with immune checkpoint inhibitors and targeted therapies. However, single biomarkers have limited predictive value, especially for programmed death-ligand 1 immunotherapy. To advance beyond the results achieved in this study, more comprehensive data on composite multiomic signatures is required.

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