Optimizing a Multivariable Logistic Regression for Identification of Perioperative Risk Factors Associated with Deep Brain Stimulator Explantation: A Retrospective Cohort Study

Background: /Objectives: Deep brain stimulation (DBS) is an effective surgical treatment for Parkinson’s disease (PD) and other movement disorders. Despite its benefits, DBS explantation occurs in 5.6% of cases, with costs exceeding $22,000 USD per implant. Traditional statistical methods have struggled to identify reliable risk factors for explantation. We hypothesized that supervised machine learning could better account for complex interactions among perioperative factors, enabling the identification of novel risk factors. Methods: The Medical Informatics Operating Room Vitals and Events Repository was queried for patients with DBS, adequate clinical data, and at least two years of follow-up (n = 38). Fisher’s exact test assessed demographic and medical history variables. Data was analyzed using Python with pandas, numpy, sklearn, sklearn-extra, matlab, and seaborn. Recursive feature elimination with cross-validation (RFECV) optimized factor selection. A multivariate logistic regression model was trained and evaluated using precision, recall, F1-score, and area under the curve (AUC). Results: Fisher’s exact test identified chronic pain (p = 0.0108) and tobacco use (p = 0.0026) as risk factors. RFECV selected 24 optimal features. The logistic regression model demonstrated strong performance (precision: 0.89, recall: 0.86, F1-score: 0.86, AUC: 1.0). Significant risk factors included tobacco use (OR: 3.64; CI: 3.60 – 3.68), primary PD (OR: 2.01; CI: 1.99 – 2.02), ASA score (OR: 1.91; CI: 1.90 – 1.92), chronic pain (OR: 1.82; CI: 1.80 – 1.85), and diabetes (OR: 1.63; CI: 1.62 – 1.65). Conclusions: Our study suggests that supervised machine learning can identify risk factors for early DBS explantation. Larger studies are needed to validate our findings.