Application of machine learning constructs to predict post-operative complications and adverse events following shoulder hemiarthroplasty

Background: Artificial intelligence (AI) constructs and machine learning (ML) algorithms have demonstrated utility in predicting various clinical, surgical, and financial outcomes. In this study, we applied AI to shoulder hemiarthroplasty (HA) to predict various post-operative complications. Methods: The sample was queried from the American college of surgeons-national surgical quality improvement program (ACS-NSQIP) database for all shoulder HA cases from 2008-2018. Six ML algorithms-random forest classifier, gradient boosting classifier, decision tree classifier, SVM classifier-tuned model, Gaussian Naïve Bayes classifier, multi-layer perception-analyzed the sample dataset. Postoperative complications included extended length of stay, non-home discharge destination, transfusion, and any adverse event. Each ML model was compared to logistic regression (LR), and model strength was evaluated. Results: We identified a total of 1585 shoulder HA cases. Mean age, BMI, operative time, and length of stay were 66±12 years, 31±8 kg/m2, 114±61 minutes, and 2.93±6.61 days. Preop hematocrit, longer operative time, and older age were most predictive of extended length of stay. Preop hematocrit, operative time, and ASA class had the highest importance in any adverse events (AAE) prediction. ML models outperformed traditional comorbidity indices, LR, for predicting extended length of stay (79% vs. 66%), non-home discharge destination (79% vs. 65%), any adverse event (78% vs. 66%), and transfusion requirement (82% vs. 63%). Conclusions: ML algorithms predicted post-surgical outcomes of interest following shoulder HA at a higher rate to conventional LR and can assist orthopedic surgeons in decision making.