title: Predicting Occurrence of Spine Surgery Complications Using "Big Data" Modeling of an Administrative Claims Database.
abstract: BACKGROUND
  Postoperative metrics are increasingly important in determining standards of quality for physicians and hospitals. Although complications following spinal surgery have been described, procedural and patient variables have yet to be incorporated into a predictive model of adverse-event occurrence. We sought to develop a predictive model of complication occurrence after spine surgery.
  
  
  METHODS
  We used longitudinal prospective data from a national claims database and developed a predictive model incorporating complication type and frequency of occurrence following spine surgery procedures. We structured our model to assess the impact of features such as preoperative diagnosis, patient comorbidities, location in the spine, anterior versus posterior approach, whether fusion had been performed, whether instrumentation had been used, number of levels, and use of bone morphogenetic protein (BMP). We assessed a variety of adverse events. Prediction models were built using logistic regression with additive main effects and logistic regression with main effects as well as all 2 and 3-factor interactions. Least absolute shrinkage and selection operator (LASSO) regularization was used to select features. Competing approaches included boosted additive trees and the classification and regression trees (CART) algorithm. The final prediction performance was evaluated by estimating the area under a receiver operating characteristic curve (AUC) as predictions were applied to independent validation data and compared with the Charlson comorbidity score.
  
  
  RESULTS
  The model was developed from 279,135 records of patients with a minimum duration of follow-up of 30 days. Preliminary assessment showed an adverse-event rate of 13.95%, well within norms reported in the literature. We used the first 80% of the records for training (to predict adverse events) and the remaining 20% of the records for validation. There was remarkable similarity among methods, with an AUC of 0.70 for predicting the occurrence of adverse events. The AUC using the Charlson comorbidity score was 0.61. The described model was more accurate than Charlson scoring (p < 0.01).
  
  
  CONCLUSIONS
  We present a modeling effort based on administrative claims data that predicts the occurrence of complications after spine surgery.
  
  
  CONCLUSIONS
  We believe that the development of a predictive modeling tool illustrating the risk of complication occurrence after spine surgery will aid in patient counseling and improve the accuracy of risk modeling strategies.
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California jratliff@stanford.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Ray
authors.initials: R
authors.lastname: Balise
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Tyler S
authors.initials: TS
authors.lastname: Cole
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Olshen
authors.affiliation: Departments of Neurosurgery (J.K.R., A.V., and T.S.C.) and Orthopaedic Surgery (I.C.), and Health and Research Policy, Division of Biostatistics (R.B., R.A.O., and L.T.), Stanford University School of Medicine, Stanford, California.
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
mesh_terms: D000328:Adult; D057225:Data Mining / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment; D013131:Spine / Q000601:surgery*; D014481:United States / Q000453:epidemiology