Operative or Nonoperative Treatment is Predicted Accurately for Patients Who Have Hip Complaints Consulting an Orthopedic Surgeon Using Machine Learning Algorithms Trained With Prehospital Acquired History-Taking Data

Abstract

Background

Increasing numbers of patients suffering from hip osteoartritis will lead to increased orthopaedic health care consumption. Artificial intelligence might alleviate this problem, but its efficacy is rarely tested in clinical practice. Machine learning (ML) might optimize orthopaedic consultation workflow by predicting treatment strategy (non-operative or operative) prior to consultation. The purpose of this study was to assess ML prediction accuracy by comparing ML predictions to the outcome of clinical consultations.

Methods

In this prospective clinical cohort study, adult patients referred for hip complaints between January 20^th to February 20^th 2023 were included. Prior to in-hospital consultation, patients completed a computer-assisted history taking (CAHT) form. Using these CAHT answers, a ML-algorithm predicted non-operative or operative treatment outcome before consultation. During consultation, orthopaedic surgeons and physician assistants were blinded to the prediction in 90 and unblinded in 29 cases. Consultation outcome (non-operative or operative) was compared to ML treatment prediction for all cases, and for blinded and unblinded conditions separately. Analysis was done on 119 consultations.

Results

Overall treatment strategy prediction was correct in 101 cases (accuracy 85%, P<0.0001). Non-operative treatment prediction (n=71) was 97% correct versus 67% for operative treatment prediction (n=48). Results from unblinded consultations (86.2% correct predictions,) were not statistically different from blinded consultations (84.4% correct, P>0.05).

Conclusion

Machine Learning algorithms can predict non-operative or operative treatment for patients with hip complaints with high accuracy. This could facilitate scheduling of non-operative patients with physician assistants, and operative patients with orthopaedic surgeons including direct access to pre-operative screening, thereby optimizing usage of health care resources.