An artificial-intelligence interpretable tool to predict risk of deep vein thrombosis after endovenous thermal ablation

Introduction: Endovenous thermal ablation (EVTA) stands as one of the primary treatments for superficial venous insufficiency. Concern exists about the potential for thromboembolic complications following this procedure. Although rare, those complications can be severe, necessitating early identification of patients prone to increased thrombotic risks. This study aims to leverage AI-based algorithms to forecast patients' likelihood of developing deep vein thrombosis (DVT) within 30 days following EVTA. Materials and Methods: From 2007 to 2017, all patients who underwent EVTA were identified using the American College of Surgeons National Surgical Quality Improvement Program database. We developed and validated 4 machine learning models using demographics, comorbidities, and laboratory values to predict the risk of postoperative deep vein thrombosis: Classification and Regression Trees (CART), Optimal Classification Trees (OCT), Random Forests, and Extreme Gradient Boosting (XGBoost). The models were trained using all the available variables. SHAP analysis was adopted to interpret model outcomes and offer medical insights into feature importance and interactions. Results: A total of 21,549 patients were included (mean age of 54 +- SD years, 67% female). In this cohort, 1.59% developed DVT. The XGBoost model had good discriminative power for predicting DVT risk with AUC of 0.711 in the hold-out test set for all-variable model. Stratification of the test set by age, BMI, preoperative white blood cell and platelet count shows that the model performs equally well across these groups. Conclusion: We developed and validated an interpretable model that enables physicians to predict which patients with superficial venous insufficiency has higher risk of developing deep vein thrombosis within 30 days following endovenous thermal ablation.