Development of Machine Learning Models for Predicting the 1-Year Risk of Reoperation After Lower Limb Oncological Resection and Endoprosthetic Reconstruction Based on Data From the PARITY Trial

Background: Oncological resection and reconstruction involving the lower extremities commonly lead to reoperations that impact patient outcomes and healthcare resources. This study aimed to develop a machine learning (ML) model to predict this reoperation risk.

Methods: This study was conducted according to TRIPOD + AI. Data from the PARITY trial was used to develop ML models to predict the 1-year reoperation risk following lower extremity oncological resection and reconstruction. Six ML algorithms were tuned and calibrated based on fivefold cross-validation. The best-performing model was identified using classification and calibration metrics.

Results: The polynomial support vector machine (SVM) model was chosen as the best-performing model. During internal validation, the SVM exhibited an AUC-ROC of 0.73 and a Brier score of 0.17. Using an optimal threshold that balances all quadrants of the confusion matrix, the SVM exhibited a sensitivity of 0.45 and a specificity of 0.81. Using a high-sensitivity threshold, the SVM exhibited a sensitivity of 0.68 and a specificity of 0.68. Total operative time was the most important feature for reoperation risk prediction.

Conclusion: The models may facilitate reoperation risk stratification, allowing for better patient counseling and for physicians to implement measures that reduce surgical risks.