Tag: satisfaction

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Machine learning models for predicting patient satisfaction after adult spinal deformity surgery

J Neurosurg Spine 44:457–468, 2026

This clinical study develops and internally validates machine learning–guided logistic regression models to predict patient satisfaction 24 months after adult spinal deformity (ASD) surgery, using 213 patients and three feature-selection methods. Nine routinely measurable predictors—including postoperative WOMAC function, frailty, pelvic compensation, imaging MCID achievement, rFCSA, and SVA—were identified and ranked by SHAP for their influence on satisfaction.

The model showed strong discrimination (AUROC 0.846) and calibration, yielded a nomogram for individualized prognostication, and emphasizes modifiable targets for perioperative care and rehabilitation. Limitations include single-center retrospective design, modest sample size, and inclusion of postoperative variables limiting preoperative decision use.

Goal Develop and internally validate models to predict patient satisfaction 24 months after adult spinal deformity (ASD) surgery, using SRS-22r satisfaction (high satisfaction defined as score ≥ 4.5).

Cohort 213 ASD patients met criteria; 128 (60%) used for training and 85 (40%) for internal test validation.

Pipeline Used three ML feature-selection methods—LASSO, recursive feature elimination (RFE), and Boruta—and retained variables consistently selected by all three.

Final predictors Nine key indicators were retained: rFCSA, fatty infiltration, frailty, pelvic compensation, postoperative SVA, imaging MCID achievement, postoperative subtotal score, postoperative WOMAC function, and change in WOMAC function.

Model Built an interpretable logistic regression model from these predictors; binary cutoff optimized via ROC/Youden index, with SHAP used to rank feature importance.

Performance In the test set, the model achieved AUROC 0.846 and accuracy 0.812 (also reported AUPRC 0.894 and Brier score 0.153).

Top drivers (SHAP order) Higher postoperative WOMAC function, absence of frailty, imaging MCID achieved, larger WOMAC function improvement, higher rFCSA, higher postoperative subtotal, lower postoperative SVA, successful pelvic compensation, and lower fatty infiltration increased satisfaction likelihood.

Implication/limitation Intended mainly to identify modifiable factors to guide postoperative rehabilitation; practical preoperative counseling is limited because key inputs include postoperative variables, and external multicenter validation is still needed.

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Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living?

J Neurosurg 117:749–754, 2012

Although decompressive hemicraniectomy has been shown to reduce death and improve functional outcome following malignant middle cerebral artery territory infarction, there is ongoing debate as to whether surgery should be routinely performed, considering the very high rates of disability and functional dependence in survivors. Through a systematic review of the literature, the authors sought to determine the outcome from a patient’s perspective.

Methods. In September 2010, a MEDLINE search of the English-language literature was performed using various combinations of 12 key words. A total of 16 papers were reviewed and individual study data were extracted.

Results. There was significant variability in study design, patient eligibility criteria, timing of surgery, and methods of outcome assessment. There were 382 patients (59% male, 41% female) with a mean age of 50 years, 25% with dominant-hemisphere infarction. The mortality rate was 24% and the mean follow-up in survivors was 19 months (range 3–114 months). Of 156 survivors with available modified Rankin Scale (mRS) scores, 41% had favorable functional outcome (mRS Score ≤ 3), whereas 47% had moderately severe disability (mRS Score 4). Among 157 survivors with quality of life assessment, the mean overall reduction was 45%: 67% for physical aspect and 37% for psychosocial aspect. Of 114 screened survivors, depression affected 56% and was moderate or severe in 25%. Most patients and/or caregivers (77% of the 209 interviewed) were satisfied and would give consent again for the procedure.

Conclusions. Despite high rates of physical disability and depression, the vast majority of patients are satisfied with life and do not regret having undergone surgery.

 

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