Study Design: Retrospective cohort study. Objectives: Leveraging electronic health records (EHRs) for spine surgery research is impeded by concerns regarding patient privacy and data ownership. Synthetic data derivatives may help overcome these limitations. This study’s objective was to validate the use of synthetic data for spine surgery research. Methods: Data came from the EHR from 15 hospitals. Patients that underwent anterior cervical or posterior lumbar fusion (2010-2020) were included. Real data were obtained from the EHR. Synthetic data was generated to simulate the properties of the real data, without maintaining a one-to-one correspondence with real patients. Within each cohort, ability to predict 30-day readmissions and 30-day complications was evaluated using logistic regression and extreme gradient boosting machines (XGBoost). Results: We identified 9,072 real and 9,088 synthetic cervical fusion patients. Descriptive characteristics were nearly identical between the 2 datasets. When predicting readmission, models built using real and synthetic data both had c-statistics of.69-.71 using logistic regression and XGBoost. Among 12,111 real and 12,126 synthetic lumbar fusion patients, descriptive characteristics were nearly the same for most variables. Using logistic regression and XGBoost to predict readmission, discrimination was similar with models built using real and synthetic data (c-statistics.66-.69). When predicting complications, models derived using real and synthetic data showed similar discrimination in both cohorts. Despite some differences, the most influential predictors were similar in the real and synthetic datasets. Conclusion: Synthetic data replicate most descriptive and predictive properties of real data, and therefore may expand EHR research in spine surgery.

Original languageEnglish
Pages (from-to)2409-2421
Number of pages13
JournalGlobal Spine Journal
Issue number8
StatePublished - Oct 2023


  • artificial intelligence
  • electronic health records
  • machine learning
  • medical informatics
  • spine surgery
  • synthetic data derivatives
  • treatment outcome


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