Machine learning-based prediction of perioperative complications in spine surgery: a large-scale model development and validation study.

Authors

Andrea Campagner, Francesco Langella, Pablo Bellosta-López, Francesca Barile, Riccardo Cecchinato, Domenico Compagnone, Marco Damilano, Claudio Lamartina, Andrea Redaelli, Daniele Vanni, Federico Cabitza, Claudia Meroni, Pedro Berjano

Published in

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Jul 27, 2026. Epub Jul 27, 2026.

Abstract

Spinal surgery carries substantial perioperative risks. Early identification of high-risk patients is critical for improving outcomes. Machine learning (ML) can enhance predictive accuracy over traditional risk scores by modeling complex clinical data, but many existing models lack large, heterogeneous cohorts.
To develop and validate ML models for predicting perioperative complications in spine surgery, and assess fairness across patient subgroups.
We conducted a retrospective cohort study of 5,060 adult patients from the SpineReg registry (2015-2023), each with 160 preoperative demographic, clinical, imaging, and patient-reported outcome features. Six ML algorithms-logistic regression (LR), decision tree, k-nearest neighbors, naïve Bayes, random forest (RF), and eXtreme gradient boosting-were trained with 80/20 train-test split, cross-validation, and hyperparameter optimization. Class imbalance was addressed via repeated undersampling. Performance was assessed using area under the ROC curve (AUC), balanced accuracy, positive predictive value (PPV), standardized net benefit (sNB), calibration, and fairness metrics.
RF achieved the best performance, obtaining an AUC of 0.87, balanced accuracy of 0.80, PPV of 0.71, and sNB of 0.44. RF maintained robust performance across demographic and surgical subgroups. Key predictors of increased complication risk included sagittal imbalance, and multilevel surgery, whereas degenerative pathology and monosegmental fusion were protective. Sensitivity declined for rare complications but exceeded 75% for most categories.
RF-based models can accurately and equitably predict perioperative complications in diverse spine surgery contexts, supporting personalized counseling, targeted monitoring, and optimized resource allocation. Integration into clinical decision support systems may enhance surgical safety and efficiency.

PMID:
42507138
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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