Machine-learning models for predicting surgical site infections using patient pre-operative risk and surgical procedure factors

  • Rabia Emhamed Al Mamlook
    Address correspondence to Rabia Emhamed Al Mamlook, PhD, Department of Industrial and Entrepreneurial Engineering & Engineering Management, Western Michigan University, 3635 kenbrooke ct, Kalamazoo, MI, 49008, USA.
    Department of Industrial and Entrepreneurial Engineering & Engineering Management, Western Michigan University, Kalamazoo, MI

    Department of Industrial, Engineering University of Zawiya, Al Zawiya City, Libya
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  • Lee J. Wells
    Department of Industrial and Entrepreneurial Engineering & Engineering Management, Western Michigan University, Kalamazoo, MI
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  • Robert Sawyer
    Department of Surgery, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI
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Published:August 21, 2022DOI:


      • This study aimed to develop and validate classification models for the occurrence of SSI to improve upon previous models.
      • Multiple risk factors for Pre-operative surgical site infection (SSI)were identified.
      • Various Machine learning and Deep Neural networks approach were compared to identify preoperative risk factors associated with SSI.
      • Deep Neural Network (DNN) model performed best on most model fit measures



      Surgical site infections (SSIs) are a significant health care problem as they can cause increased medical costs and increased morbidity and mortality. Assessing a patient's preoperative risk factors can improve risk stratification and help guide the surgical decision-making process. Previous efforts to use preoperative risk factors to predict the occurrence of SSIs have relied upon traditional statistical modeling approaches. The aim of this paper is to develop and validate, using state-of-the-art machine learning (ML) approaches, classification models for the occurrence of SSI to improve upon previous models.


      In this work, using the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) database, the performances (eg prediction accuracy) of 7 different ML approaches (Logistic Regression (LR), Naïve Bayesian (NB), Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), Artificial Neural Network (ANN), and Deep Neural Network (DNN)) were compared. The performance of these models was evaluated using the area under the curve, accuracy, precision, sensitivity, and F1-score metrics.


      Overall, 2,882,526 surgical procedures were identified in the study for the SSI predictive models’ development. The results indicate that the DNN model offers the best predictive performance with 10-fold compared to the other 6 approaches considered (area under the curve = 0.8518, accuracy = 0.8518, precision = 0.8517, sensitivity = 0.8527, F1-score = 0.8518). Emergency case surgeries, American Society of Anesthesiologists (ASA) Index of 4 (ASA_4), BMI, Vascular surgeries, and general surgeries were most significant influencing features towards developing an SSI.


      Equally important is that the commonly used LR approach for SSI prediction displayed mediocre performance. The results are encouraging as they suggest that the prediction performance for SSIs can be improved using modern ML approaches.


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