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Predicting readmission after bariatric surgery using machine learning
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DOI：10.1016/j.soard.2023.05.025.png)
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Background: While bariatric surgery is an effective method for achieving long-term weight loss, postoperative readmissions are associated with negative clinical outcomes and significant costs. Objectives: We aimed to use machine learning (ML) algorithms to predict readmissions and compare results to logistic regression. Setting: Hospitals participating in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, United States. Methods: Patients who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and bil-iopancreatic diversion with duodenal switch between 2016 and 2020 were selected from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Patient vari-ables reported by the MBSAQIP database were analyzed by ML algorithms random forest (RF), gradient boosting (XGB), and deep neural networks (NN), and the results of the predictive models were compared to logistic regression using area under the receiver operating characteristic curve (AUROC). Results: Our study included 863,348 patients, of which 39,068 (4.52%) were readmitted. AUROC scores were XGB .785 (95% CI .784-.786), RF .785 (95% CI .784-.785), and NN .754 (95% CI .753-.754), compared with .62 (95% CI .62-.621) for logistic regression (LR) (P ,.001). The sensi-tivity and specificity for XGB, the best performing model, were 73.81% and 70%, compared with 52.94% and 70% for logistic regression. The most important variables were intervention or reopera-tion prior to discharge, unplanned ICU admission, initial procedure, and the intraoperative transfusion. Conclusions: ML demonstrates significant advantages over logistic regression when predicting 30-day readmission following bariatric surgery. With external validation, models could identify the best candidates for early discharge or targeted postdischarge resources. (Surg Obes Relat Dis 2023;19:1236-1245.) (c) 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Keyword:
Machine learning
Bariatric surgery
Predictive modeling
Readmission
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