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Predicting 1-Year Mortality after Hip Fracture Surgery: An Evaluation of Multiple Machine Learning Approaches
Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3583-3443
Örebro University, School of Medical Sciences. Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA.ORCID iD: 0000-0002-1918-9443
Örebro University, School of Medical Sciences. Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0003-3436-1026
Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-7097-487X
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2021 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 11, no 8, article id 727Article in journal (Refereed) Published
Abstract [en]

Postoperative death within 1 year following hip fracture surgery is reported to be up to 27%. In the current study, we benchmarked the predictive precision and accuracy of the algorithms support vector machine (SVM), naïve Bayes classifier (NB), and random forest classifier (RF) against logistic regression (LR) in predicting 1-year postoperative mortality in hip fracture patients as well as assessed the relative importance of the variables included in the LR model. All adult patients who underwent primary emergency hip fracture surgery in Sweden, between 1 January 2008 and 31 December 2017 were included in the study. Patients with pathological fractures and non-operatively managed hip fractures, as well as those who died within 30 days after surgery, were excluded from the analysis. A LR model with an elastic net regularization were fitted and compared to NB, SVM, and RF. The relative importance of the variables in the LR model was then evaluated using the permutation importance. The LR model including all the variables demonstrated an acceptable predictive ability on both the training and test datasets for predicting one-year postoperative mortality (Area under the curve (AUC) = 0.74 and 0.74 respectively). NB, SVM, and RF tended to over-predict the mortality, particularly NB and SVM algorithms. In contrast, LR only over-predicted mortality when the predicted probability of mortality was larger than 0.7. The LR algorithm outperformed the other three algorithms in predicting 1-year postoperative mortality in hip fracture patients. The most important predictors of 1-year mortality were the presence of a metastatic carcinoma, American Society of Anesthesiologists(ASA) classification, sex, Charlson Comorbidity Index (CCI) ≤ 4, age, dementia, congestive heart failure, hypertension, surgery using pins/screws, and chronic kidney disease.

Place, publisher, year, edition, pages
MDPI, 2021. Vol. 11, no 8, article id 727
Keywords [en]
Hip fracture, logistic regression, machine learning, postoperative mortality, prediction, variable importance
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-93947DOI: 10.3390/jpm11080727ISI: 000689604300001PubMedID: 34442370Scopus ID: 2-s2.0-85111710257OAI: oai:DiVA.org:oru-93947DiVA, id: diva2:1589105
Available from: 2021-08-30 Created: 2021-08-30 Last updated: 2024-03-06Bibliographically approved

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Forssten, Maximilian PeterBass, Gary AlanMohammad Ismail, AhmadMohseni, ShahinCao, Yang

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Forssten, Maximilian PeterBass, Gary AlanMohammad Ismail, AhmadMohseni, ShahinCao, Yang
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