The London Spine Unit : best rated day surgery spinal centre in London
Published article
CONCLUSIONS: The GBE model predicted total charges and associated cost drivers associated with ambulatory single-level lumbar decompression using a large, statewide database with excellent performance. External validation of this algorithm in future studies may guide practical application of this clinical tool.
Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
World Neurosurg. 2022 Sep 8:S1878-8750(22)01276-1. doi: 10.1016/j.wneu.2022.08.149. Online ahead of print.
ABSTRACT
BACKGROUND: With the emergence of the concept of value-based care, efficient resource allocation has become an increasingly prominent factor in surgical decision-making. Validated machine learning (ML) models for cost prediction in outpatient spine surgery are limited. As such, we developed and internally validated a supervised ML algorithm to reliably identify cost drivers associated with ambulatory single level lumbar decompression surgery.
METHODS: A retrospective review of the New York State Ambulatory Surgical Database (NYSASD) was performed to identify patients who underwent single level lumbar decompression from 2014-2015. Patients with a length of stay (LOS)>0 were excluded. Using pre and intraoperative parameters (features) derived from the NYSASD, an optimal supervised ML model was ultimately developed and internally validated after five candidate models were rigorously tested, trained, and compared for predictive performance related to total charges. The best performing model was then evaluated by testing its performance on identifying relationships between features of interest and cost prediction. Finally, the best performing algorithm was entered into an open-access web application.
RESULTS: 8,402 patients were included. The gradient-boosted ensemble (GBE) model demonstrated the best performance assessed via internal validation. Major cost drivers included anesthesia type, operating room (OR) time, race, patient income and insurance status, community type, worker’s compensation status and comorbidity index.
CONCLUSIONS: The GBE model predicted total charges and associated cost drivers associated with ambulatory single-level lumbar decompression using a large, statewide database with excellent performance. External validation of this algorithm in future studies may guide practical application of this clinical tool.
PMID:36089278 | DOI:10.1016/j.wneu.2022.08.149
The London Spine Unit : best rated day surgery spinal centre in London
Read the original publication: