• James Booker, Jack Penn, Kawsar Noor, Richard J B Dobson, Jonathan P Funnell, Chan Hee Koh, Danyal Z Khan, Nicola Newall, David Rowland, Siddharth Sinha, Simon C Williams, Parag Sayal, and Hani J Marcus.
• Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK. James.booker.19@ucl.ac.uk.
• Eur Spine J. 2024 Jul 1; 33 (7): 254525522545-2552.

PurposeAccessible patient information sources are vital in educating patients about the benefits and risks of spinal surgery, which is crucial for obtaining informed consent. We aim to assess the effectiveness of a natural language processing (NLP) pipeline in recognizing surgical procedures from clinic letters and linking this with educational resources.MethodsRetrospective examination of letters from patients seeking surgery for degenerative spinal disease at a single neurosurgical center. We utilized MedCAT, a named entity recognition and linking NLP, integrated into the electronic health record (EHR), which extracts concepts and links them to systematized nomenclature of medicine-clinical terms (SNOMED-CT). Investigators reviewed clinic letters, identifying words or phrases that described or identified operations and recording the SNOMED-CT terms as ground truth. This was compared to SNOMED-CT terms identified by the model, untrained on our dataset. A pipeline linking clinic letters to patient-specific educational resources was established, and precision, recall, and F1 scores were calculated.ResultsAcross 199 letters the model identified 582 surgical procedures, and the overall pipeline after adding rules a total of 784 procedures (precision = 0.94, recall = 0.86, F1 = 0.91). Across 187 letters with identified SNOMED-CT terms the integrated pipeline linking education resources directly to the EHR was successful in 157 (78%) patients (precision = 0.99, recall = 0.87, F1 = 0.92).ConclusionsNLP accurately identifies surgical procedures in pre-operative clinic letters within an untrained subspecialty. Performance varies among letter authors and depends on the language used by clinicians. The identified procedures can be linked to patient education resources, potentially improving patients' understanding of surgical procedures.© 2024. The Author(s).

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