Predicting Inpatient Length of Stay After Brain Tumor Surgery: Developing Machine Learning Ensembles to Improve Predictive Performance

• Published in: Neurosurgery Vol. 85; no. 3; pp. 384 - 393
• Main Authors: Muhlestein, Whitney E, Akagi, Dallin S, Davies, Jason M, Chambless, Lola B
• Format: Journal Article
• Language: English
• Published: United States Copyright by the Congress of Neurological Surgeons 01.09.2019; Oxford University Press; Wolters Kluwer Health, Inc
• Subjects: Algorithms; Brain; Brain cancer; Brain Neoplasms - surgery; Brain tumors; Clinical Decision Rules; Clinical outcomes; Female; Humans; Inpatients; Length of Stay; Machine Learning; Male; Middle Aged; Neurosurgery; Prognosis; Regression Analysis; Research—Human—Clinical Studies; Serbia; Predictive modeling; Outcomes; Machine learning; Length of stay
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyy343

BACKGROUND:Current outcomes prediction tools are largely based on and limited by regression methods. Utilization of machine learning (ML) methods that can handle multiple diverse inputs could strengthen predictive abilities and improve patient outcomes. Inpatient length of stay (LOS) is one such outcome that serves as a surrogate for patient disease severity and resource utilization. OBJECTIVE:To develop a novel method to systematically rank, select, and combine ML algorithms to build a model that predicts LOS following craniotomy for brain tumor. METHODS:A training dataset of 41 222 patients who underwent craniotomy for brain tumor was created from the National Inpatient Sample. Twenty-nine ML algorithms were trained on 26 preoperative variables to predict LOS. Trained algorithms were ranked by calculating the root mean square logarithmic error (RMSLE) and top performing algorithms combined to form an ensemble. The ensemble was externally validated using a dataset of 4592 patients from the National Surgical Quality Improvement Program. Additional analyses identified variables that most strongly influence the ensemble model predictions. RESULTS:The ensemble model predicted LOS with RMSLE of .555 (95% confidence interval, .553-.557) on internal validation and .631 on external validation. Nonelective surgery, preoperative pneumonia, sodium abnormality, or weight loss, and non-White race were the strongest predictors of increased LOS. CONCLUSION:An ML ensemble model predicts LOS with good performance on internal and external validation, and yields clinical insights that may potentially improve patient outcomes. This systematic ML method can be applied to a broad range of clinical problems to improve patient care.