• Whitney E Muhlestein, Dallin S Akagi, Jason M Davies, and Lola B Chambless.
• Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
• Neurosurgery. 2019 Sep 1; 85 (3): 384-393.

BackgroundCurrent outcomes prediction tools are largely based on and limited by regression methods. Utilization of machine learning (ML) methods that can handle multiple diverse inputs could strengthen predictive abilities and improve patient outcomes. Inpatient length of stay (LOS) is one such outcome that serves as a surrogate for patient disease severity and resource utilization.ObjectiveTo develop a novel method to systematically rank, select, and combine ML algorithms to build a model that predicts LOS following craniotomy for brain tumor.MethodsA training dataset of 41 222 patients who underwent craniotomy for brain tumor was created from the National Inpatient Sample. Twenty-nine ML algorithms were trained on 26 preoperative variables to predict LOS. Trained algorithms were ranked by calculating the root mean square logarithmic error (RMSLE) and top performing algorithms combined to form an ensemble. The ensemble was externally validated using a dataset of 4592 patients from the National Surgical Quality Improvement Program. Additional analyses identified variables that most strongly influence the ensemble model predictions.ResultsThe ensemble model predicted LOS with RMSLE of .555 (95% confidence interval, .553-.557) on internal validation and .631 on external validation. Nonelective surgery, preoperative pneumonia, sodium abnormality, or weight loss, and non-White race were the strongest predictors of increased LOS.ConclusionAn ML ensemble model predicts LOS with good performance on internal and external validation, and yields clinical insights that may potentially improve patient outcomes. This systematic ML method can be applied to a broad range of clinical problems to improve patient care.Copyright © 2018 by the Congress of Neurological Surgeons.

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