Machine Learning in Cardiac Surgery: Predicting Mortality and Readmission

Predicting outcomes in open-heart surgery can be challenging. Unexpected readmissions, long hospital stays, and mortality have economic implications. In this study, we investigated machine learning (ML) performance in data visualization and predicting patient outcomes associated with open-heart surgery. We evaluated 8,947 patients who underwent cardiac surgery from April 2006 to January 2018. Data visualization and classification were performed at cohort-level and patient-level using clustering, correlation matrix, and seven different predictive models for predicting three outcomes ("Discharged," "Died," and "Readmitted") at binary level. Cross-validation was used to train and test each dataset with the application of hyperparameter optimization and data imputation techniques. Machine learning showed promising performance for predicting mortality (AUC 0.83 ± 0.03) and readmission (AUC 0.75 ± 0.035). The cohort-level analysis revealed that ML performance is comparable to the Society of Thoracic Surgeons (STS) risk model even with limited number of samples (e.g., less than 3,000 samples for ML versus more than 100,000 samples for the STS risk models). With all cases (8,947 samples, referred as patient-level analysis), ML showed comparable performance to what has been reported for the STS models. However, we acknowledge that it remains unknown at this stage as to how the model might perform outside the institution and does not in any way constitute a comparison of the performance of the internal model with the STS model. Our study demonstrates a systematic application of ML in analyzing and predicting outcomes after open-heart surgery. The predictive utility of ML in cardiac surgery and clinical implications of the results are highlighted.