Utilization of machine learning methods for predicting surgical outcomes after total knee arthroplasty

Document Type

Journal Article

Publication Date



PloS one








BACKGROUND: Predictive models could help clinicians identify risk factors that cause adverse events after total knee arthroplasty (TKA), allowing for appropriate preoperative preventive interventions and allocation of resources. METHODS: The National Inpatient Sample datasets from 2010-2014 were used to build Logistic Regression (LR), Gradient Boosting Method (GBM), Random Forest (RF), and Artificial Neural Network (ANN) predictive models for three clinically relevant outcomes after TKA-disposition at discharge, any post-surgical complications, and blood transfusion. Model performance was evaluated using the Brier scores as calibration measures, and area under the ROC curve (AUC) and F1 scores as discrimination measures. RESULTS: GBM-based predictive models were observed to have better calibration and discrimination than the other models; thus, indicating comparatively better overall performance. The Brier scores for GBM models predicting the outcomes under investigation ranged from 0.09-0.14, AUCs ranged from 79-87%, and F1-scores ranged from 41-73%. Variable importance analysis for GBM models revealed that admission month, patient location, and patient's income level were significant predictors for all the outcomes. Additionally, any post-surgical complications and blood transfusions were significantly predicted by deficiency anemias, and discharge disposition by length of stay and age groups. Notably, any post-surgical complications were also significantly predicted by the patient undergoing blood transfusion. CONCLUSIONS: The predictive abilities of the ML models were successfully demonstrated using data from the National Inpatient Sample (NIS), indicating a wide range of clinical applications for obtaining accurate prognoses of complications following orthopedic surgical procedures.


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