{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T04:30:43Z","timestamp":1780633843319,"version":"3.54.1"},"reference-count":57,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T00:00:00Z","timestamp":1657670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Decompression of the lumbar spine is one of the most common procedures performed in spine surgery. Hospital length of stay (LOS) is a clinically relevant metric used to assess surgical success, patient outcomes, and socioeconomic impact. This study aimed to investigate a variety of machine learning and deep learning algorithms to reliably predict whether a patient undergoing decompression of lumbar spinal stenosis will experience a prolonged LOS. Methods: Patients undergoing treatment for lumbar spinal stenosis with microsurgical and full-endoscopic decompression were selected within this retrospective monocentric cohort study. Prolonged LOS was defined as an LOS greater than or equal to the 75th percentile of the cohort (normal versus prolonged stay; binary classification task). Unsupervised learning with K-means clustering was used to find clusters in the data. Hospital stay classes were predicted with logistic regression, RandomForest classifier, stochastic gradient descent (SGD) classifier, K-nearest neighbors, Decision Tree classifier, Gaussian Naive Bayes (GaussianNB), support vector machines (SVM), a custom-made convolutional neural network (CNN), multilayer perceptron artificial neural network (MLP), and radial basis function neural network (RBNN) in Python. Prediction accuracy and area under the curve (AUC) were calculated. Feature importance analysis was utilized to find the most important predictors. Further, we developed a decision tree based on the Chi-square automatic interaction detection (CHAID) algorithm to investigate cut-offs of predictors for clinical decision-making. Results: 236 patients and 14 feature variables were included. K-means clustering separated data into two clusters distinguishing the data into two patient risk characteristic groups. The algorithms reached AUCs between 67.5% and 87.3% for the classification of LOS classes. Feature importance analysis of deep learning algorithms indicated that operation time was the most important feature in predicting LOS. A decision tree based on CHAID could predict 84.7% of the cases. Conclusions: Machine learning and deep learning algorithms can predict whether patients will experience an increased LOS following lumbar decompression surgery. Therefore, medical resources can be more appropriately allocated to patients who are at risk of prolonged LOS.<\/jats:p>","DOI":"10.3390\/jcm11144050","type":"journal-article","created":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T22:06:00Z","timestamp":1657749960000},"page":"4050","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Performance of Artificial Intelligence-Based Algorithms to Predict Prolonged Length of Stay after Lumbar Decompression Surgery"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2298-3696","authenticated-orcid":false,"given":"Babak","family":"Saravi","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical Center\u2014University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany"},{"name":"Department of Spine Surgery, Loretto Hospital, 79108 Freiburg, Germany"},{"name":"Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisia","family":"Zink","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Loretto Hospital, 79108 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"\u00dclk\u00fcmen","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Loretto Hospital, 79108 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8486-6412","authenticated-orcid":false,"given":"Sebastien","family":"Couillard-Despres","sequence":"additional","affiliation":[{"name":"Institute of Experimental Neuroregeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Paracelsus Medical University, 5020 Salzburg, Austria"},{"name":"Austrian Cluster for Tissue Regeneration, 1200 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5618-9285","authenticated-orcid":false,"given":"Frank","family":"Hassel","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Loretto Hospital, 79108 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0685-1909","authenticated-orcid":false,"given":"Gernot","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical Center\u2014University of Freiburg, Faculty of Medicine, University of Freiburg, 79108 Freiburg, Germany"},{"name":"Department of Spine Surgery, Loretto Hospital, 79108 Freiburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"h6234","DOI":"10.1136\/bmj.h6234","article-title":"Management of Lumbar Spinal Stenosis","volume":"352","author":"Lurie","year":"2016","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1093\/pm\/pnz161","article-title":"A Review of Lumbar Spinal Stenosis with Intermittent Neurogenic Claudication: Disease and Diagnosis","volume":"20","author":"Deer","year":"2019","journal-title":"Pain Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.spinee.2007.10.005","article-title":"A Systematic Review of Low Back Pain Cost of Illness Studies in the United States and Internationally","volume":"8","author":"Dagenais","year":"2008","journal-title":"Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults","volume":"303","author":"Deyo","year":"2010","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.3171\/2018.5.SPINE18184","article-title":"US Regional Variations in Rates, Outcomes, and Costs of Spinal Arthrodesis for Lumbar Spinal Stenosis in Working Adults Aged 40\u201365 Years","volume":"30","author":"Raad","year":"2018","journal-title":"J. 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