Zero-shot generation of synthetic neurosurgical data with large language models

Abstract: Clinical data is fundamental to advance neurosurgical research, but access is often constrained by data availability, small sample sizes, privacy regulations, and resource-intensive preprocessing and de-identification procedures. Synthetic data offers a potential solution to challenges associated with accessing and using real-world data (RWD). This study aims to evaluate the capability of zero-shot generation of synthetic neurosurgical data with a LLM, GPT-4o, by benchmarking with the conditional tabular generative adversarial network (CTGAN). Synthetic datasets were compared to real-world neurosurgical data to assess fidelity (means, proportions, distributions, and bivariate correlations), utility (ML classifier performance on RWD), and privacy (duplication of records from RWD). The GPT-4o-generated datasets matched or exceeded CTGAN performance, despite no fine-tuning or access to RWD for pre-training. Datasets demonstrated high univariate and bivariate fidelity to RWD without directly exposing any real patient records, even at amplified sample size. Training an ML classifier on GPT-4o-generated data and testing on RWD for a binary prediction task showed an F1 score (0.706) with comparable performance to training on the CTGAN data (0.705) for predicting postoperative functional status deterioration. GPT-4o demonstrated a promising ability to generate high-fidelity synthetic neurosurgical data. These findings also indicate that data synthesized with GPT-4o can effectively augment clinical data with small sample sizes, and train ML models for prediction of neurosurgical outcomes. Further investigation is necessary to improve the preservation of distributional characteristics and boost classifier performance.