SURGE-ahead postoperative delirium prediction: external validation and open-source library.

Purpose: In this prospective external validation study, we examined the performance of the Supporting SURgery with GEriatric Co-Management and AI (SURGE-Ahead) postoperative delirium (POD) prediction algorithm. SURGE-Ahead is a collaborative project that aims to develop a clinical decision support system that uses predictive models to support geriatric co-management in surgical wards. Delirium is a common complication in older adults after surgery, leading to poor outcomes and increased healthcare costs. Early and accurate prediction of POD is crucial for timely intervention and prevention strategies.

Methods: The SURGE-Ahead algorithm utilizes a linear support vector machine model with a comprehensive set of 15 clinical and demographic features. In our validation, we analyzed 173 study participants, of which 50 developed POD.

Results: The study found that the SURGE-Ahead POD prediction algorithm yielded state-of-the-art performance, using only preoperative data, with a receiver operating characteristics area under the curve of 0.86. In addition, the SURGE-Ahead algorithm exhibited good calibration as shown by a Brier Score of 0.14. The algorithm is openly available on GitHub, facilitating its implementation and adaptation to different surgical settings.

Conclusion: Our findings contribute to the development of reliable POD prediction tools, ultimately supporting the improvement of patient care in hospitalized older adults.