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A Machine Learning Approach to Determine the Optimal Age for Total Hip Arthroplasty: When Is Risk for Adverse
Chloe Heiting1, Yiyuan Wu, Susan M Goodman
1From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY (Heiting), Weill Cornell Medicine, New York, NY (Wu, Goodman, Wang, and Mehta), Hospital for Special Surgery, New York, NY (Goodman, Sculco, and Mehta), Sidney Kimmel Medical College, Philadelphia, PA (Ibrahim), University of Maryland School of Medicine, Baltimore, MD (Cram), and Intelligible Inc., Redmond, WA (Caruana).
The optimal age for total hip arthroplasty (THA) is between 52.5 and 71.5 years, offering the lowest risk of adverse outcomes. This finding helps in planning and selecting the best age for THA surgery.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Total hip arthroplasty (THA) utilization is increasing across all age groups due to lifestyle changes and surgical advancements.
- While complication rates are generally low, they remain a critical factor in THA planning.
- Identifying optimal patient demographics for THA is essential for minimizing adverse outcomes.
Purpose of the Study:
- To determine the age-specific risks associated with total hip arthroplasty (THA).
- To identify the optimal age range for THA that minimizes the risk of adverse outcomes.
- To provide data-driven insights for surgical planning and patient selection in THA.
Main Methods:
- Retrospective analysis of primary elective THA patients from the Pennsylvania Health Care Cost Containment Council Database (2012-2018).
- Development of a supervised, explainable boosting machine model to predict risks of 90-day readmission, 90-day mortality, 1-year revision, and longer length of stay (LOS).
- Assessment of age-related risks and visualization of interactions between age and other covariates.
Main Results:
- The study included 105,336 patients with readmission, mortality, and revision rates of 8.0%, 0.3%, and 1.5%, respectively.
- Age was a significant predictor of adverse THA outcomes, demonstrating a nonlinear relationship.
- Specific age ranges were identified for increased risk of readmission (48.5-71.5 years), mortality (after 79.5 years), and revision (before 46.5 years), while longer LOS decreased between 52.5-74.5 years.
Conclusions:
- Adverse outcomes following THA exhibit a nonlinear association with patient age.
- The optimal age range for THA to achieve the lowest risk of adverse outcomes is estimated to be between 52.5 and 71.5 years.
- These findings offer a more nuanced approach to risk quantification and aid in the planning and selection of THA procedures.