PMID- 31869249
OWN - NLM
STAT- MEDLINE
DCOM- 20200915
LR  - 20200915
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 48
IP  - 2
DP  - 2020 Feb
TI  - Application of Machine Learning for Predicting Clinically Meaningful Outcome 
      After Arthroscopic Femoroacetabular Impingement Surgery.
PG  - 415-423
LID - 10.1177/0363546519892905 [doi]
AB  - BACKGROUND: Hip arthroscopy has become an important tool for surgical treatment 
      of intra-articular hip pathology. Predictive models for clinically meaningful 
      outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement 
      syndrome (FAIS) are unknown. PURPOSE: To apply a machine learning model to 
      determine preoperative variables predictive for achieving the minimal clinically 
      important difference (MCID) at 2 years after hip arthroscopy for FAIS. STUDY 
      DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were analyzed for 
      patients who underwent hip arthroscopy for FAIS by a high-volume 
      fellowship-trained surgeon between January 2012 and July 2016. The MCID cutoffs 
      for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport 
      Specific (HOS-SS), and modified Harris Hip Score (mHHS) were 9.8, 14.4, and 9.14, 
      respectively. Predictive models for achieving the MCID with respect to each were 
      built with the LASSO algorithm (least absolute shrinkage and selection operator) 
      for feature selection, followed by logistic regression on the selected features. 
      Study data were analyzed with PatientIQ, a cloud-based research and analytics 
      platform for health care. RESULTS: Of 1103 patients who met inclusion criteria, 
      898 (81.4%) had a minimum of 2-year reported outcomes and were entered into the 
      modeling algorithm. A total of 74.0%, 73.5%, and 79.9% met the HOS-ADL, HOS-SS, 
      and mHHS threshold scores for achieving the MCID. Predictors of not achieving the 
      HOS-ADL MCID included anxiety/depression, symptom duration for >2 years before 
      surgery, higher body mass index, high preoperative HOS-ADL score, and 
      preoperative hip injection (all P < .05). Predictors of not achieving the HOS-SS 
      MCID included anxiety/depression, preoperative symptom duration for >2 years, 
      high preoperative HOS-SS score, and preoperative hip injection, while running at 
      least at the recreational level was a predictor of achieving HOS-SS MCID (all P < 
      .05). Predictors of not achieving the mHHS MCID included history of anxiety or 
      depression, high preoperative mHHS score, and hip injections, while being female 
      was predictive of achieving the MCID (all P < .05). CONCLUSION: This study 
      identified predictive variables for achieving clinically meaningful outcome after 
      hip arthroscopy for FAIS. Patient factors including anxiety/depression, symptom 
      duration >2 years, preoperative intra-articular injection, and high preoperative 
      outcome scores are most consistently predictive of inability to achieve 
      clinically meaningful outcome. These findings have important implications for 
      shared decision-making algorithms and management of preoperative expectations 
      after hip arthroscopy for FAI.
FAU - Nwachukwu, Benedict U
AU  - Nwachukwu BU
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Hospital for 
      Special Surgery, New York, New York, USA.
FAU - Beck, Edward C
AU  - Beck EC
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest 
      Baptist Health, Winston-Salem, North Carolina, USA.
FAU - Lee, Elaine K
AU  - Lee EK
AD  - PatientIQ, Chicago, Illinois, USA.
FAU - Cancienne, Jourdan M
AU  - Cancienne JM
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Waterman, Brian R
AU  - Waterman BR
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest 
      Baptist Health, Winston-Salem, North Carolina, USA.
FAU - Paul, Katlynn
AU  - Paul K
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
FAU - Nho, Shane J
AU  - Nho SJ
AD  - Division of Sports Medicine, Department of Orthopedic Surgery, Rush University 
      Medical Center, Chicago, Illinois, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20191223
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Activities of Daily Living
MH  - Adult
MH  - Arthroscopy/*methods
MH  - Body Mass Index
MH  - Case-Control Studies
MH  - Female
MH  - Femoracetabular Impingement/*surgery
MH  - Hip Joint/*surgery
MH  - Humans
MH  - *Machine Learning
MH  - Male
MH  - Middle Aged
MH  - Minimal Clinically Important Difference
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Hip Outcome Score
OT  - MCID
OT  - PatientIQ
OT  - femoroacetabular impingement syndrome
OT  - modified Hip Harris Score
OT  - predictive modeling
EDAT- 2019/12/24 06:00
MHDA- 2020/09/17 06:00
CRDT- 2019/12/24 06:00
PHST- 2019/12/24 06:00 [pubmed]
PHST- 2020/09/17 06:00 [medline]
PHST- 2019/12/24 06:00 [entrez]
AID - 10.1177/0363546519892905 [doi]
PST - ppublish
SO  - Am J Sports Med. 2020 Feb;48(2):415-423. doi: 10.1177/0363546519892905. Epub 2019 
      Dec 23.