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Deep learning on automated performance metrics and clinical features to predict urinary continence recovery after robot-assisted radical prostatectomy.


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Deep learning on automated performance metrics and clinical features to predict urinary continence recovery after robot-assisted radical prostatectomy.

BJU Int. 2019 Feb 27;:

Authors: Hung AJ, Chen J, Ghodoussipour S, Oh PJ, Liu Z, Nguyen J, Purushotham S, Gill IS, Liu Y

Abstract
OBJECTIVES: To predict urinary continence recovery after robot-assisted radical prostatectomy (RARP) utilizing a deep learning (DL) model, which was then used to evaluate surgeon’s historical patient outcomes.
SUBJECTS AND METHODS: Robotic surgical automated performance metrics (APMs) during RARPs, patient clinicopathological and continence data were captured prospectively from 100 contemporary RARPs. We trained a DL model (DeepSurv) to predict post-operative urinary continence. Model features were ranked based on their importance in prediction. We stratified eight surgeons based on the five top-ranked features. The top four surgeons were categorized in “Group 1/APMs” versus “Group 2/APMs”. A separate historical cohort of RARPs (January 2015 to August 2016) performed by these two surgeon groups were then compared. Concordance Index (CI) and Mean Absolute Error (MAE) were used to measure the model’s prediction performance. Outcomes of historical cases were compared using the Kruskal-Wallis test, Chi-squared and Fisher’s exact test.
RESULTS: Continence was attained in 79 patients (79%) after a median of 126 days. The DL model achieved CI of 0.6, MAE of 85.9 in predicting continence. APMs were ranked higher by the model than clinicopathological features. In the historical cohort, “Group 1/APM” patients had superior rates of urinary continence at three and six months postoperatively (47.5 vs 36.7%, p=0.034, and 68.3 vs 59.2%, p=0.047, respectively).
CONCLUSION: Utilizing APMs and clinicopathological data the DeepSurv model was able to predict continence after RARP. In this feasibility study, surgeons with more efficient APMs had higher continence rates at three and six months after RARP. This article is protected by copyright. All rights reserved.

PMID: 30811828 [PubMed – as supplied by publisher]

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