论文标题
可解释的神经网络回归对术前阿片类药物使用的个性化风险评估
Individualized Risk Assessment of Preoperative Opioid Use by Interpretable Neural Network Regression
论文作者
论文摘要
据报道,术前使用阿片类药物与术前的阿片类药物需求较高,术后结局较差以及术后医疗保健利用率和支出相关。了解术前阿片类药物使用的风险有助于建立以患者为中心的疼痛管理。在机器学习领域,由于其出色的预测能力,深度神经网络(DNN)已成为风险评估的强大手段。但是,黑框算法可能使结果不如统计模型解释。弥合统计和机器学习领域之间的差距,我们提出了一种新颖的可解释的神经网络回归(内部),该回归结合了统计和DNN模型的优势。我们使用拟议的内部进行术前使用阿片类药物的个性化风险评估。密集的模拟和对34186名预期手术的患者的分析(AOS)的分析表明,所提出的内部不仅可以准确预测使用术前特征作为DNN的术前使用的阿片类药物,还可以估算出在不疼痛的情况下增加触发趋势的患者的特定趋势,从而在整体上增加了趋势,并且在整体上增加了趋势,并且可以在整体上增加趋势。阿片类药物比DNN。我们的结果确定了与阿片类药物使用密切相关的患者特征,并且在很大程度上与先前的发现相一致,从而证明了内部是术前使用阿片类药物的个性化风险评估的有用工具。
Preoperative opioid use has been reported to be associated with higher preoperative opioid demand, worse postoperative outcomes, and increased postoperative healthcare utilization and expenditures. Understanding the risk of preoperative opioid use helps establish patient-centered pain management. In the field of machine learning, deep neural network (DNN) has emerged as a powerful means for risk assessment because of its superb prediction power; however, the blackbox algorithms may make the results less interpretable than statistical models. Bridging the gap between the statistical and machine learning fields, we propose a novel Interpretable Neural Network Regression (INNER), which combines the strengths of statistical and DNN models. We use the proposed INNER to conduct individualized risk assessment of preoperative opioid use. Intensive simulations and an analysis of 34,186 patients expecting surgery in the Analgesic Outcomes Study (AOS) show that the proposed INNER not only can accurately predict the preoperative opioid use using preoperative characteristics as DNN, but also can estimate the patient specific odds of opioid use without pain and the odds ratio of opioid use for a unit increase in the reported overall body pain, leading to more straightforward interpretations of the tendency to use opioids than DNN. Our results identify the patient characteristics that are strongly associated with opioid use and is largely consistent with the previous findings, providing evidence that INNER is a useful tool for individualized risk assessment of preoperative opioid use.