Jason A. Brant

Background To develop machine learning (ML) models predicting unplanned readmission and reoperation among patients undergoing free flap reconstruction for head and neck (HN) surgery. Methods Data were extracted from the 2012–2019 NSQIP database. eXtreme Gradient Boosting (XGBoost) was used to develop ML models predicting 30‐day readmission and reoperation based on demographic and perioperative factors. Models were validated using 2019 data and evaluated. Results Four‐hundred and sixty‐six (10.7%) of 4333 included patients were readmitted within 30 days of initial surgery. The ML model demonstrated 82% accuracy, 63% sensitivity, 85% specificity, and AUC of 0.78. Nine‐hundred and four (18.3%) of 4931 patients underwent reoperation within 30 days of index surgery. The ML model demonstrated 62% accuracy, 51% sensitivity, 64% specificity, and AUC of 0.58. Conclusion XGBoost was used to predict 30‐day readmission and reoperation for HN free flap patients. Findings may be used to assist clinicians and patients in shared decision‐making and improve data collection in future database iterations.