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Artificial intelligence-based analysis of associations between learning curve and clinical outcomes in endoscopic and microsurgical lumbar decompression surgery – Lumbar Spinal Stenosis

This article, published in European Spine Journal, explores the impact of a surgeon’s learning curve on clinical outcomes in lumbar spine decompression surgery. The study conducted a retrospective cohort analysis of patients with lumbar spinal stenosis treated with microsurgical and full-endoscopic decompression. The researchers used machine learning algorithms to predict prolonged lengths of stay, extended operating times, and complications based on the surgeon’s learning curve and other clinical parameters. The results showed that patient characteristics had a more significant effect on clinical outcomes than the surgeon’s learning curve or the surgical technique. The study suggests that the provided prediction tools can be used to determine the likelihood of increased LOS, OT, or complications in lumbar decompression surgery. The algorithms need further validation through large-scale randomized controlled trials before being implemented in clinical practice

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated day surgery spinal centre in UK

Published article

CONCLUSIONS: A median of 72 cases of FED surgeries led to comparable clinical outcomes in the early learning curve phase compared to experienced surgeons. These outcomes seem to be more significantly affected by patient characteristics than the learning curve or the surgical technique. Several study variables, including the learning curve, can be used to predict whether lumbar decompression surgery will result in an increased LOS, OT, or complications. To introduce the provided prediction tools…

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Eur Spine J. 2023 Dec 29. doi: 10.1007/s00586-023-08084-7. Online ahead of print.ABSTRACTPURPOSE: A common spine surgery procedure involves decompression of the lumbar spine. The impact of the surgeon’s learning curve on relevant clinical outcomes is currently not well examined in the literature. A variety of machine learning algorithms have been investigated in this study to,

Eur Spine J. 2023 Dec 29. doi: 10.1007/s00586-023-08084-7. Online ahead of print.

ABSTRACT

PURPOSE: A common spine surgery procedure involves decompression of the lumbar spine. The impact of the surgeon’s learning curve on relevant clinical outcomes is currently not well examined in the literature. A variety of machine learning algorithms have been investigated in this study to determine how a surgeon’s learning curve and other clinical parameters will influence prolonged lengths of stay (LOS), extended operating times (OT), and complications, as well as whether these clinical parameters can be reliably predicted.

METHODS: A retrospective monocentric cohort study of patients with lumbar spinal stenosis treated with microsurgical (MSD) and full-endoscopic (FED) decompression was conducted. The study included 206 patients with lumbar spinal stenosis who underwent FED (63; 30.6%) and MSD (118; 57.3%). Prolonged LOS and OT were defined as those exceeding the 75th percentile of the cohort. Furthermore, complications were assessed as a dependent variable. Using unsupervised learning, clusters were identified in the data, which helped distinguish between the early learning curve (ELC) and the late learning curve (LLC). From 15 algorithms, the top five algorithms that best fit the data were selected for each prediction task. We calculated the accuracy of prediction (Acc) and the area under the curve (AUC). The most significant predictors were determined using a feature importance analysis.

RESULTS: For the FED group, the median number of surgeries with case surgery type at the time of surgery was 72 in the ELC group and 274 in the LLC group. FED patients did not significantly differ in outcome variables (LOS, OT, complication rate) between the ELC and LLC group. The random forest model demonstrated the highest mean accuracy and AUC across all folds for each classification task. For OT, it achieved an accuracy of 76.08% and an AUC of 0.89. For LOS, the model reached an accuracy of 83.83% and an AUC of 0.91. Lastly, in predicting complications, the random forest model attained the highest accuracy of 89.90% and an AUC of 0.94. Feature importance analysis indicated that LOS, OT, and complications were more significantly affected by patient characteristics than the surgical technique (FED versus MSD) or the surgeon’s learning curve.

CONCLUSIONS: A median of 72 cases of FED surgeries led to comparable clinical outcomes in the early learning curve phase compared to experienced surgeons. These outcomes seem to be more significantly affected by patient characteristics than the learning curve or the surgical technique. Several study variables, including the learning curve, can be used to predict whether lumbar decompression surgery will result in an increased LOS, OT, or complications. To introduce the provided prediction tools into clinics, the algorithms need to be implemented into open-source software and externally validated through large-scale randomized controlled trials.

PMID:38156994 | DOI:10.1007/s00586-023-08084-7

The London Spine Unit : best situated day surgery spinal centre in UK

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Artificial intelligence-based analysis of associations between learning curve and clinical outcomes in endoscopic and microsurgical lumbar decompression surgery

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Eur Spine J. 2023 Dec 29. doi: 10.1007/s00586-023-08084-7. Online ahead of print.ABSTRACTPURPOSE: A common spine surgery procedure involves decompression of the lumbar spine. The impact of the surgeon's learning curve on relevant clinical outcomes is currently not well examined in the literature. A variety of machine learning algorithms have been investigated in this study to

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