An Artificial Intelligence Approach to Predicting Unplanned Intubation Following Anterior Cervical Discectomy and Fusion

• Published in: Global spine journal Vol. 13; no. 7; pp. 1849 - 1855
• Main Authors: Veeramani, Ashwin, Zhang, Andrew S, Blackburn, Amy Z., Etzel, Christine M., DiSilvestro, Kevin J., McDonald, Christopher L., Daniels, Alan H.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-09-2023; Sage Publications Ltd
• Subjects: Algorithms; Artificial intelligence; Intubation; Machine learning; Original; complications; unplanned intubation; anterior cervical discectomy and fusion surgery
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/21925682211053593

Study Design
Level III retrospective database study.
Objectives
The purpose of this study is to determine if machine learning algorithms are effective in predicting unplanned intubation following anterior cervical discectomy and fusion (ACDF).
Methods
The National Surgical Quality Initiative Program (NSQIP) was queried to select patients who had undergone ACDF. Machine learning analysis was conducted in Python and multivariate regression analysis was conducted in R. C-Statistics area under the curve (AUC) and prediction accuracy were used to measure the classifier’s effectiveness in distinguishing cases.
Results
In total, 54 502 patients met the study criteria. Of these patients, .51% underwent an unplanned re-intubation. Machine learning algorithms accurately classified between 72%-100% of the test cases with AUC values of between .52-.77. Multivariable regression indicated that the number of levels fused, male sex, COPD, American Society of Anesthesiologists (ASA) > 2, increased operating time, Age > 65, pre-operative weight loss, dialysis, and disseminated cancer were associated with increased risk of unplanned intubation.
Conclusions
The models presented here achieved high accuracy in predicting risk factors for re-intubation following ACDF surgery. Machine learning analysis may be useful in identifying patients who are at a higher risk of unplanned post-operative re-intubation and their treatment plans can be modified to prophylactically prevent respiratory compromise and consequently unplanned re-intubation.