Prediction of spinal cord injury after thoracoabdominal aortic repair by machine learning method

Spinal cord injury (SCI) is a severe complication after thoracoabdominal aortic repair (TAAR), substantially increasing postoperative mortality and disability. This study aimed to develop an improved machine learning model using comprehensive perioperative data to predict SCI risk.

270 patients were included in the study, and 66 potentially meaningful variables were selected from 84 original variables as input data to drive machine learning. An optimized machine learning algorithm (PSO-FLXGBoost) was applied to stratify and rank predictors, and Shapley additive explanations (SHAP) were used to interpret feature contributions.

The PSO-FLXGBoost model achieved strong discrimination with an AUC of 0.895. SHAP analysis highlighted four key predictors: intraoperative hemoglobin < 70 g/L, preoperative D-dimer > 6 µg/mL, platelet count > 250 × 10^9/L, and operation time > 500 min, all of which significantly increased SCI risk.

The optimized PSO-FLXGBoost model reliably predicts SCI after TAAR, emphasizing intraoperative hemoglobin, coagulation status, and operative duration as critical risk factors. These insights may guide tailored perioperative strategies to improve patient outcomes.