Department of Surgery, Massachusetts General Hospital, Boston, MA.
Department of Psychology, Tufts University, Medford, MA.
Surgery. 2021 Apr;169(4):750-754. doi: 10.1016/j.surg.2020.06.049. Epub 2020 Sep 9.
Setting patient and family expectations for postoperative outcomes is an important aspect of care, a cornerstone of which is accurate, personalized, and explainable risk estimation. Modern machine learning offers a plethora of models that can effectively capture the complex, nonlinear contributions of preoperative risk factors to the surgical patient's overall risk. However, most of these models produce risk estimates that are not interpretable, which compromises trust in these systems, renders them unaccountable, and limits their widespread adoption. Recent developments in machine learning have been successful at creating risk calculators that address this gap, producing explainable risk estimates without compromising accuracy. In this work, we describe how the state of the art in postoperative risk estimation addresses the shortcomings of older methods, and how they have been applied in a clinical setting. We conclude with a discussion of the potential of machine learning models to be systematically integrated in health care more broadly and future prospects beyond passive risk prediction.
为术后结果设定患者和家属的预期是护理的一个重要方面,其基石是准确、个性化和可解释的风险评估。现代机器学习提供了大量的模型,可以有效地捕捉术前风险因素对手术患者整体风险的复杂、非线性影响。然而,大多数这些模型产生的风险估计是不可解释的,这损害了对这些系统的信任,使它们无法负责,并限制了它们的广泛采用。机器学习的最新发展成功地创建了风险计算器,解决了这一差距,在不影响准确性的情况下产生可解释的风险估计。在这项工作中,我们描述了术后风险估计的最新技术如何解决旧方法的缺点,以及它们如何在临床环境中得到应用。最后,我们讨论了机器学习模型在更广泛的医疗保健中系统集成的潜力,以及超越被动风险预测的未来前景。