Deep learning-based preoperative predictive analytics for patient-reported outcomes following lumbar discectomy: feasibility of center-specific modeling

BACKGROUND CONTEXT: There is considerable variability in patient-reported outcome measures following surgery for lumbar disc herniation. Individualized prediction tools that are derived from center-or even surgeon-specific data could provide valuable insights for shared decision-making. PURPOSE: To evaluate the feasibility of deriving robust deep learning-based predictive analytics from single-center, single-surgeon data. STUDY DESIGN: Derivation of predictive models from a prospective registry. PATIENT SAMPLE: Patients who underwent single-level tubular microdiscectomy for lumbar disc herniation. OUTCOME MEASURES: Numeric rating scales for leg and back pain severity and Oswestry Disability Index scores at 12 months postoperatively. METHODS: Data were derived from a prospective registry. We trained deep neural networkbased and logistic regression-based prediction models for patient-reported outcome measures. The primary endpoint was achievement of the minimum clinically important difference (MCID) in numeric rating scales and Oswestry Disability Index, defined as a 30% or greater improvement from baseline. Univariate predictors of MCID were also identified using conventional statistics. RESULTS: A total of 422 patients were included (mean [SD] age: 48.5 [11.5] years; 207 [49%] female). After 1 year, 337 (80%), 219 (52%), and 337 (80%) patients reported a clinically relevant improvement in leg pain, back pain, and functional disability, respectively. The deep learning models predicted MCID with high area-under-the-curve of 0.87, 0.90, and 0.84, as well as accuracy of 85%, 87%, and 75%. The regression models provided inferior performancemeasures for each of the outcomes. CONCLUSIONS: Our study demonstrates that generating personalized and robust deep learningbased analytics for outcome prediction is feasible even with limited amounts of center-specific data. With prospective validation, the ability to preoperatively and reliably inform patients about the likelihood of symptom improvement could prove useful in patient counselling and shared decision-making. (c) 2018 Elsevier Inc. All rights reserved.