Artificial intelligence prediction model for readmission after DIEP flap breast reconstruction based on NSQIP data

Abstract

Background

Readmissions following deep inferior epigastric perforator (DIEP) flap breast reconstruction represent a significant healthcare burden, yet current risk prediction methods lack precision in identifying high-risk patients. We developed a machine learning model to predict 30-day readmission risk using a large national surgical quality database.

Methods

This retrospective analysis examined 13,312 DIEP flap procedures from the American College of Surgeons National Surgical Quality Improvement Program database (2016–2022). A stacked machine learning model was developed incorporating patient demographics, comorbidities, operative characteristics, and laboratory values. Model performance was assessed using accuracy, precision, recall, and F1 score.

Results

The overall readmission rate was 5.42% (723 patients). The stacked model achieved 88% accuracy and 79% recall for readmission prediction with an area under the receiver operating characteristic curve of 0.8921 (95% CI: 0.853–0.927) on the test set. Key predictors included days from operation until superficial incisional surgical site infection complications, operative time, body mass index, and preoperative albumin.

Conclusion

This stacked machine learning approach demonstrates strong predictive capability for post-DIEP flap readmissions, with high sensitivity for identifying at-risk patients. The model’s performance suggests clinical utility in preoperative risk stratification and resource allocation. Implementation could enable targeted intervention strategies to potentially reduce readmission rates in high-risk populations.