Aram, P., Trela-Larsen, L., Sayers, A. et al. (5 more authors) (2018) Estimating an individual's probability of revision surgery after knee replacement : a comparison of modeling approaches using a national dataset. American Journal of Epidemiology, 187 (10). pp. 2252-2262. ISSN 0002-9262
Abstract
Tools that provide personalized risk prediction of the outcomes after surgical procedures help patients to make preference-based decisions amongst the available treatment options. However, it is unclear which modeling approach provides the most accurate risk estimation. We constructed and compared several parametric and non-parametric models for predicting prosthesis survivorship after knee replacement surgery for osteoarthritis. We used 430,455 patient-procedure episodes between April 2003 and September 2015 from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. The flexible parametric survival and random survival forest models most accurately captured the observed probability of remaining event-free. The concordance index for the flexible parametric model was the highest (0.705; 95% confidence interval: 0.702, 0.707) for total knee replacement, 0.639 (95% confidence interval: 0.634, 0.643) for unicondylar knee replacement and 0.589 (95% confidence interval: 0.586, 0.592) for patellofemoral replacement. The observed-to-predicted ratios for both the flexible parametric and the random survival forest approaches indicated that models tended to underestimate the risks for most risk groups. Our results show that the flexible parametric model has a better overall performance compared to other tested parametric methods, and better discrimination compared to the random survival forest approach.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access a rticle distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the or iginal work is properly cited. |
Keywords: | Knee replacement; revision surgery; time-to-event analysis; random survival forest; flexible parametric survival model; parametric survival model; calibration; discrimination |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Engineering (Sheffield) > Department of Automatic Control and Systems Engineering (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number ARTHRITIS RESEARCH UK 20894 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 26 Jul 2018 11:38 |
Last Modified: | 15 Jul 2020 10:07 |
Published Version: | https://doi.org/10.1093/aje/kwy121 |
Status: | Published |
Publisher: | Oxford University Press |
Refereed: | Yes |
Identification Number: | 10.1093/aje/kwy121 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:132150 |