Explainable machine learning models for prediction of surgical site infection after posterior lumbar fusion surgery based on SHAP.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
PeiYang Wang, Lei Liu, ZhiYang Xie, GuanRui Ren, YiLi Hu, MeiJi Shen, Hui Wang, JiaDong Wang, YunTao Wang, Xiao-Tao Wu
{"title":"Explainable machine learning models for prediction of surgical site infection after posterior lumbar fusion surgery based on SHAP.","authors":"PeiYang Wang, Lei Liu, ZhiYang Xie, GuanRui Ren, YiLi Hu, MeiJi Shen, Hui Wang, JiaDong Wang, YunTao Wang, Xiao-Tao Wu","doi":"10.1016/j.wneu.2025.123942","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study OBJECTIVES: This study aims to develop machine learning (ML) models combined with an explainable method for the prediction of surgical site infection (SSI) after posterior lumbar fusion surgery.</p><p><strong>Methods: </strong>In this retrospective, single-center study, a total of 1016 consecutive patients who underwent posterior lumbar fusion surgery were included. A comprehensive dataset was established, encompassing demographic variables, comorbidities, preoperative evaluation, details related to diagnosed lumbar disease, preoperative laboratory tests, surgical specifics, and postoperative factors. Utilizing this dataset, six ML models were developed to predict the occurrence of SSI. Performance evaluation of the models on the testing set involved several metrics, including the Receiver Operating Characteristic (ROC) curve, the Area Under the Curve (AUC), accuracy, recall, F1-score, and precision. The Shapley Additive Explanations (SHAP) method was employed to generate interpretable predictions, enabling a comprehensive assessment of SSI risk and providing individualized interpretations of the model results.</p><p><strong>Results: </strong>Among the 1016 retrospective cases included in the study, 36 (3.54%) experienced SSI. Out of the six models examined, the XGBoost model demonstrated the highest discriminatory performance on the testing set, achieving the following metrics: precision (0.9000), recall (0.8182), accuracy (0.9902), F1 score (0.8571), and AUC (0.9447). By utilizing the SHAP method, several important predictors of SSI were identified, including the duration of indwelling jugular vein catheter, Bun levels, total protein levels, sustained fever, Cr levels, triglycerides levels, monocyte count, diabetes mellitus, drainage time, white blood cell count, cerebral infarction, estimated blood loss, prealbumin levels, prognostic nutritional index, low back pain, PF score, and osteoporosis.</p><p><strong>Conclusion: </strong>ML-based prediction tools can accurately assess the risk of SSI after posterior lumbar fusion surgery. Additionally, ML combined with SHAP could provide a clear interpretation of individualized risk prediction and give physicians an intuitive comprehension of the effects of the model's essential features.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123942"},"PeriodicalIF":1.9000,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2025.123942","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Study design: Retrospective study OBJECTIVES: This study aims to develop machine learning (ML) models combined with an explainable method for the prediction of surgical site infection (SSI) after posterior lumbar fusion surgery.

Methods: In this retrospective, single-center study, a total of 1016 consecutive patients who underwent posterior lumbar fusion surgery were included. A comprehensive dataset was established, encompassing demographic variables, comorbidities, preoperative evaluation, details related to diagnosed lumbar disease, preoperative laboratory tests, surgical specifics, and postoperative factors. Utilizing this dataset, six ML models were developed to predict the occurrence of SSI. Performance evaluation of the models on the testing set involved several metrics, including the Receiver Operating Characteristic (ROC) curve, the Area Under the Curve (AUC), accuracy, recall, F1-score, and precision. The Shapley Additive Explanations (SHAP) method was employed to generate interpretable predictions, enabling a comprehensive assessment of SSI risk and providing individualized interpretations of the model results.

Results: Among the 1016 retrospective cases included in the study, 36 (3.54%) experienced SSI. Out of the six models examined, the XGBoost model demonstrated the highest discriminatory performance on the testing set, achieving the following metrics: precision (0.9000), recall (0.8182), accuracy (0.9902), F1 score (0.8571), and AUC (0.9447). By utilizing the SHAP method, several important predictors of SSI were identified, including the duration of indwelling jugular vein catheter, Bun levels, total protein levels, sustained fever, Cr levels, triglycerides levels, monocyte count, diabetes mellitus, drainage time, white blood cell count, cerebral infarction, estimated blood loss, prealbumin levels, prognostic nutritional index, low back pain, PF score, and osteoporosis.

Conclusion: ML-based prediction tools can accurately assess the risk of SSI after posterior lumbar fusion surgery. Additionally, ML combined with SHAP could provide a clear interpretation of individualized risk prediction and give physicians an intuitive comprehension of the effects of the model's essential features.

求助全文
约1分钟内获得全文 求助全文
来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信