Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction
Summary:. Two-stage implant-based reconstruction after mastectomy may require secondary revision procedures to treat complications, correct defects, and improve aesthetic outcomes. Patients should be counseled on the possibility of additional procedures during the initial visit, but the likelihood o...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-03-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005542 |
| _version_ | 1797243087451324416 |
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| author | Yunchan Chen, BS Ashley Zhang, BSE Marcos Lu Wang, BA Grant G. Black, BA George Zhou, BS David M. Otterburn, MD |
| author_facet | Yunchan Chen, BS Ashley Zhang, BSE Marcos Lu Wang, BA Grant G. Black, BA George Zhou, BS David M. Otterburn, MD |
| author_sort | Yunchan Chen, BS |
| collection | DOAJ |
| description | Summary:. Two-stage implant-based reconstruction after mastectomy may require secondary revision procedures to treat complications, correct defects, and improve aesthetic outcomes. Patients should be counseled on the possibility of additional procedures during the initial visit, but the likelihood of requiring another procedure is dependent on many patient- and surgeon-specific factors. This study aims to identify patient-specific factors and surgical techniques associated with higher rates of secondary procedures and offer a machine learning model to compute individualized assessments for preoperative counseling. A training set of 209 patients (406 breasts) who underwent two-stage alloplastic reconstruction was created, with 45.57% of breasts (185 of 406) requiring revisional or unplanned surgery. On multivariate analysis, hypertension, no tobacco use, and textured expander use corresponded to lower odds of additional surgery. In contrast, higher initial tissue expander volume, vertical radial incision, and larger nipple-inframammary fold distance conferred higher odds of additional surgery. The neural network model trained on clinically significant variables achieved the highest collective performance metrics, with ROC AUC of 0.74, sensitivity of 84.2, specificity of 63.6, and accuracy of 62.1. The proposed machine learning model trained on a single surgeon’s data offers a precise and reliable tool to assess an individual patient’s risk of secondary procedures. Machine learning models enable physicians to tailor surgical planning and empower patients to make informed decisions aligned with their lifestyle and preferences. The utilization of this technology is especially applicable to plastic surgery, where outcomes are subject to a variety of patient-specific factors and surgeon practices, including threshold to perform secondary procedures. |
| first_indexed | 2024-04-24T18:49:32Z |
| format | Article |
| id | doaj.art-60eb159b375e4b498c58f8a0d1341fb8 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-24T18:49:32Z |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-60eb159b375e4b498c58f8a0d1341fb82024-03-27T03:41:49ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-03-01123e554210.1097/GOX.0000000000005542202403000-00036Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast ReconstructionYunchan Chen, BS0Ashley Zhang, BSE1Marcos Lu Wang, BA2Grant G. Black, BA3George Zhou, BS4David M. Otterburn, MD5From * Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, N.Y.† Division of Plastic and Reconstructive Surgery, Columbia University Irving Medical Center, New York, N.Y.From * Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, N.Y.From * Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, N.Y.From * Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, N.Y.From * Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, N.Y.Summary:. Two-stage implant-based reconstruction after mastectomy may require secondary revision procedures to treat complications, correct defects, and improve aesthetic outcomes. Patients should be counseled on the possibility of additional procedures during the initial visit, but the likelihood of requiring another procedure is dependent on many patient- and surgeon-specific factors. This study aims to identify patient-specific factors and surgical techniques associated with higher rates of secondary procedures and offer a machine learning model to compute individualized assessments for preoperative counseling. A training set of 209 patients (406 breasts) who underwent two-stage alloplastic reconstruction was created, with 45.57% of breasts (185 of 406) requiring revisional or unplanned surgery. On multivariate analysis, hypertension, no tobacco use, and textured expander use corresponded to lower odds of additional surgery. In contrast, higher initial tissue expander volume, vertical radial incision, and larger nipple-inframammary fold distance conferred higher odds of additional surgery. The neural network model trained on clinically significant variables achieved the highest collective performance metrics, with ROC AUC of 0.74, sensitivity of 84.2, specificity of 63.6, and accuracy of 62.1. The proposed machine learning model trained on a single surgeon’s data offers a precise and reliable tool to assess an individual patient’s risk of secondary procedures. Machine learning models enable physicians to tailor surgical planning and empower patients to make informed decisions aligned with their lifestyle and preferences. The utilization of this technology is especially applicable to plastic surgery, where outcomes are subject to a variety of patient-specific factors and surgeon practices, including threshold to perform secondary procedures.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005542 |
| spellingShingle | Yunchan Chen, BS Ashley Zhang, BSE Marcos Lu Wang, BA Grant G. Black, BA George Zhou, BS David M. Otterburn, MD Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction Plastic and Reconstructive Surgery, Global Open |
| title | Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction |
| title_full | Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction |
| title_fullStr | Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction |
| title_full_unstemmed | Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction |
| title_short | Using a Machine Learning Approach to Predict the Need for Elective Revision and Unplanned Surgery after Implant-based Breast Reconstruction |
| title_sort | using a machine learning approach to predict the need for elective revision and unplanned surgery after implant based breast reconstruction |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000005542 |
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