Explainable machine-learning predictions for the prevention of hypoxaemia during surgery

Although anaesthesiologists strive to avoid hypoxaemia during surgery, reliably predicting future intraoperative hypoxaemia is not possible at present. Here, we report the development and testing of a machine-learning-based system that predicts the risk of hypoxaemia and provides explanations of the risk factors in real time during general anaesthesia. The system, which was trained on minute-by-minute data from the electronic medical records of over 50,000 surgeries, improved the performance of anaesthesiologists by providing interpretable hypoxaemia risks and contributing factors. The explanations for the predictions are broadly consistent with the literature and with prior knowledge from anaesthesiologists. Our results suggest that if anaesthesiologists currently anticipate 15% of hypoxaemia events, with the assistance of this system they could anticipate 30%, a large portion of which may benefit from early intervention because they are associated with modifiable factors. The system can help improve the clinical understanding of hypoxaemia risk during anaesthesia care by providing general insights into the exact changes in risk induced by certain characteristics of the patient or procedure.