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- Title
Personalized application of machine learning algorithms to identify pediatric patients at risk for recurrent ureteropelvic junction obstruction after dismembered pyeloplasty.
- Authors
Drysdale, Erik; Khondker, Adree; Kim, Jin K.; Kwong, Jethro C. C.; Erdman, Lauren; Chua, Michael; Keefe, Daniel T.; Lolas, Marisol; Dos Santos, Joana; Tasian, Gregory; Rickard, Mandy; Lorenzo, Armando J.
- Abstract
Purpose: To develop a model that predicts whether a child will develop a recurrent obstruction after pyeloplasty, determine their survival risk score, and expected time to re-intervention using machine learning (ML). Methods: We reviewed patients undergoing pyeloplasty from 2008 to 2020 at our institution, including all children and adolescents younger than 18 years. We developed a two-stage machine learning model from 34 clinical fields, which included patient characteristics, ultrasound findings, and anatomical variation. We fit and trained with a logistic lasso model for binary cure model and subsequent survival model. Feature importance on the model was determined with post-selection inference. Performance metrics included area under the receiver-operating-characteristic (AUROC), concordance, and leave-one-out cross validation. Results: A total of 543 patients were identified, with a median preoperative and postoperative anteroposterior diameter of 23 and 10 mm, respectively. 39 of 232 patients included in the survival model required re-intervention. The cure and survival models performed well with a leave-one-out cross validation AUROC and concordance of 0.86 and 0.78, respectively. Post-selective inference showed that larger anteroposterior diameter at the second post-op follow-up, and anatomical variation in the form of concurrent anomalies were significant model features predicting negative outcomes. The model can be used at https://sickkidsurology.shinyapps.io/PyeloplastyReOpRisk/. Conclusion: Our ML-based model performed well in predicting the risk of and time to re-intervention after pyeloplasty. The implementation of this ML-based approach is novel in pediatric urology and will likely help achieve personalized risk stratification for patients undergoing pyeloplasty. Further real-world validation is warranted.
- Subjects
URETERIC obstruction; CHILD patients; MACHINE learning; SURVIVAL analysis (Biometry); DISEASE risk factors
- Publication
World Journal of Urology, 2022, Vol 40, Issue 2, p593
- ISSN
0724-4983
- Publication type
Article
- DOI
10.1007/s00345-021-03879-z