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Development, Validation, and Comparison of Machine Learning Models for Predicting Pediatric Surgical Site Infections

Carrie T Chan1,2, Mark J Pletcher1, Karthik Balakrishnan3

  • 1From the Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA (Chan, Pletcher, Hswen, Scheffler).

Journal of the American College of Surgeons
|November 3, 2025
PubMed
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This summary is machine-generated.

Machine learning models can predict surgical site infections (SSIs) in children. A regularized logistic regression model shows promise for clinical integration to personalize SSI risk and prevention strategies.

Area of Science:

  • Pediatric Surgery
  • Infectious Disease Epidemiology
  • Health Informatics

Background:

  • Surgical site infections (SSIs) significantly increase pediatric postoperative morbidity.
  • Rising SSI rates contrast with their largely preventable nature.
  • Existing SSI prediction models are primarily designed for adult populations, necessitating pediatric-specific tools.

Purpose of the Study:

  • To develop, validate, and compare machine learning (ML) models for predicting pediatric SSI risk.
  • To identify a suitable ML model for seamless integration into clinical workflows.
  • To enhance individualized risk assessment and targeted infection prevention strategies for pediatric patients.

Main Methods:

  • Retrospective cohort analysis of over 1.1 million pediatric cases from the NSQIP-P database (2012-2022).

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  • Development and comparison of five ML models: logistic regression, random forest, gradient boosted trees, k-nearest neighbors, and neural networks.
  • Performance evaluation using Brier scores, c-statistics, and calibration metrics, with bootstrap resampling for confidence intervals.
  • Main Results:

    • All developed ML models demonstrated comparable performance in predicting pediatric SSIs.
    • Regularized logistic regression exhibited strong predictive accuracy (c-statistic 0.77, Brier score 0.023) and was selected for its clinical feasibility.
    • Key predictors of SSI risk included procedural codes, diagnoses, comorbidities, acuity markers, laboratory values, and patient demographics.

    Conclusions:

    • Machine learning models effectively predict pediatric SSI risk utilizing preoperative data.
    • The proposed regularized logistic regression model is a strong candidate for EHR integration, enabling personalized SSI risk estimation.
    • Future work includes external validation and user-centered implementation studies to facilitate clinical adoption.