• Akash A Shah, Sai K Devana, Changhee Lee, Thomas E Olson, Alexander Upfill-Brown, William L Sheppard, Elizabeth L Lord, Arya N Shamie, Mihaela van der Schaar, Nelson F SooHoo, and Don Y Park.
• Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
• Spine. 2023 Apr 1; 48 (7): 460467460-467.

Study DesignA retrospective, case-control study.ObjectiveWe aim to build a risk calculator predicting major perioperative complications after anterior cervical fusion. In addition, we aim to externally validate this calculator with an institutional cohort of patients who underwent anterior cervical discectomy and fusion (ACDF).Summary Of Background DataThe average age and proportion of patients with at least one comorbidity undergoing ACDF have increased in recent years. Given the increased morbidity and cost associated with perioperative complications and unplanned readmission, accurate risk stratification of patients undergoing ACDF is of great clinical utility.MethodsThis is a retrospective cohort study of adults who underwent anterior cervical fusion at any nonfederal California hospital between 2015 and 2017. The primary outcome was major perioperative complication or 30-day readmission. We built standard and ensemble machine learning models for risk prediction, assessing discrimination, and calibration. The best-performing model was validated on an external cohort comprised of consecutive adult patients who underwent ACDF at our institution between 2013 and 2020.ResultsA total of 23,184 patients were included in this study; there were 1886 cases of major complication or readmissions. The ensemble model was well calibrated and demonstrated an area under the receiver operating characteristic curve of 0.728. The variables most important for the ensemble model include male sex, medical comorbidities, history of complications, and teaching hospital status. The ensemble model was evaluated on the validation cohort (n=260) with an area under the receiver operating characteristic curve of 0.802. The ensemble algorithm was used to build a web-based risk calculator.ConclusionWe report derivation and external validation of an ensemble algorithm for prediction of major perioperative complications and 30-day readmission after anterior cervical fusion. This model has excellent discrimination and is well calibrated when tested on a contemporaneous external cohort of ACDF cases.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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