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Open AccessArticle

Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison

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Division of Orthopedic Surgery, Yuan’s General Hospital, Kaohsiung 80249, Taiwan
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Department of Medical Education & Research, Yuan’s General Hospital, Kaohsiung 80249, Taiwan
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Superintendent and Division of Gastrointestinal Surgery, Yuan’s General Hospital, Kaohsiung 80249, Taiwan
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Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
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Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
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Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan
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Author to whom correspondence should be addressed.
Medicina 2020, 56(5), 243; https://doi.org/10.3390/medicina56050243
Received: 25 March 2020 / Revised: 13 May 2020 / Accepted: 13 May 2020 / Published: 19 May 2020
(This article belongs to the Special Issue Artificial Intelligence Research in Healthcare)
This study purposed to validate the accuracy of an artificial neural network (ANN) model for predicting the mortality after hip fracture surgery during the study period, and to compare performance indices between the ANN model and a Cox regression model. A total of 10,534 hip fracture surgery patients during 1996–2010 were recruited in the study. Three datasets were used: a training dataset (n = 7374) was used for model development, a testing dataset (n = 1580) was used for internal validation, and a validation dataset (1580) was used for external validation. Global sensitivity analysis also was performed to evaluate the relative importances of input predictors in the ANN model. Mortality after hip fracture surgery was significantly associated with referral system, age, gender, urbanization of residence area, socioeconomic status, Charlson comorbidity index (CCI) score, intracapsular fracture, hospital volume, and surgeon volume (p < 0.05). For predicting mortality after hip fracture surgery, the ANN model had higher prediction accuracy and overall performance indices compared to the Cox model. Global sensitivity analysis of the ANN model showed that the referral to lower-level medical institutions was the most important variable affecting mortality, followed by surgeon volume, hospital volume, and CCI score. Compared with the Cox regression model, the ANN model was more accurate in predicting postoperative mortality after a hip fracture. The forecasting predictors associated with postoperative mortality identified in this study can also bae used to educate candidates for hip fracture surgery with respect to the course of recovery and health outcomes. View Full-Text
Keywords: hip fracture surgery; artificial neural network; cox regression; mortality hip fracture surgery; artificial neural network; cox regression; mortality
MDPI and ACS Style

Chen, C.-Y.; Chen, Y.-F.; Chen, H.-Y.; Hung, C.-T.; Shi, H.-Y. Artificial Neural Network and Cox Regression Models for Predicting Mortality after Hip Fracture Surgery: A Population-Based Comparison. Medicina 2020, 56, 243.

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