Explainable prediction of hypothermia risk in laparoscopic surgery: a retrospective cross-sectional study using machine learning.

Abstract

Objective: This study aims to develop multiple machine learning models for predicting hypothermia risk in laparoscopic surgery and to perform interpretability analysis of the best-performing model. Our goal is to provide robust decision support for clinicians and ensure safe and effective patient care during surgical procedures.

Methods: This study included 1,030 patients who underwent laparoscopic surgery at Shandong Provincial Cancer Hospital, affiliated with Shandong First Medical University, between July 2023 and June 2024. We employed the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm for feature selection. We explored the performance of five machine learning algorithms-logistic regression (LR), decision tree (DT), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost)-to predict hypothermia risk during laparoscopic surgery. Finally, we conducted an interpretability analysis of the top-performing model using Shapley Additive Explanations (SHAP).

Results: LASSO identified nine risk factors: BMI, ASA classification, total volume of intravenous fluids, irrigating fluids during the operation, volume of CO₂, blood loss, ambient temperature, long-term alcohol consumption, and type of surgery. Performance comparison among the five models revealed that the XGBoost model performed the best, with an accuracy of 0.762 (95% CI: 0.717-0.807) and an area under the curve (AUC) of 0.835 (95% CI: 0.794-0.872). The model achieved a specificity of 0.749 (95% CI: 0.683-0.816) and a sensitivity of 0.773 (95% CI: 0.713-0.824). The F1 score was 0.778 (95% CI: 0.735-0.828). SHAP analysis revealed that the four most influential factors for hypothermia risk during laparoscopic surgery were operating room temperature, rinsing fluids during the operation, volume of CO2, and blood loss.

Conclusions: This study developed an efficient and interpretable predictive model for the risk of hypothermia in patients undergoing laparoscopic surgery. This model supports clinical decision-making and contributes to the overall goal of providing personalized care in the surgical environment.