Machine learning to predict outcomes following endovascular abdominal aortic aneurysm repair

Background Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) carries important perioperative risks; however, there are no widely used outcome prediction tools. The aim of this study was to apply machine learning (ML) to develop automated algorithms that predict 1-year mortality following EVAR.Methods The Vascular Quality Initiative database was used to identify patients who underwent elective EVAR for infrarenal AAA between 2003 and 2023. Input features included 47 preoperative demographic/clinical variables. The primary outcome was 1-year all-cause mortality. Data were split into training (70 per cent) and test (30 per cent) sets. Using 10-fold cross-validation, 6 ML models were trained using preoperative features with logistic regression as the baseline comparator. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). Model robustness was evaluated with calibration plot and Brier score.Results Some 63 655 patients were included. One-year mortality occurred in 3122 (4.9 per cent) patients. The best performing prediction model for 1-year mortality was XGBoost, achieving an AUROC (95 per cent c.i.) of 0.96 (0.95-0.97). Comparatively, logistic regression had an AUROC (95 per cent c.i.) of 0.69 (0.68-0.71). The calibration plot showed good agreement between predicted and observed event probabilities with a Brier score of 0.04. The top 3 predictive features in the algorithm were 1) unfit for open AAA repair, 2) functional status, and 3) preoperative dialysis.Conclusions In this data set, machine learning was able to predict 1-year mortality following EVAR using preoperative data and outperformed standard logistic regression models. Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm carries important perioperative risks; however, there are no widely used outcome prediction tools. Using the multicentre Vascular Quality Initiative database consisting of 63 655 patients who underwent elective EVAR between 2003 and 2023, we developed robust machine learning models that accurately predict 1-year postoperative mortality with an area under the receiver operating characteristic curve of 0.96. Our automated algorithms can help guide risk mitigation strategies for patients being considered for EVAR to improve outcomes.

Automated summary

Machine learning algorithms were used to develop automated algorithms that accurately predict 1-year mortality following EVAR, outperforming standard logistic regression models.