Predicting 30-Day In-Hospital Mortality in Surgical Patients: A Logistic Regression Model Using Comprehensive Perioperative Data

Abstract

AbstractBackgroundAccurate prediction of postoperative outcomes, particularly 30-day in-hospital mortality, is crucial for improving surgical planning, patient counseling, and resource allocation. This study aimed to develop and validate a logistic regression model to predict 30-day in-hospital mortality using comprehensive perioperative data from the INSPIRE dataset.MethodsWe conducted a retrospective analysis of the INSPIRE dataset, comprising approximately 130,000 surgical cases from Seoul National University Hospital between 2011 and 2020. The primary objective was to develop a logistic regression model using preoperative and intraoperative variables. Key predictors included demographic information, clinical variables, laboratory values, and the emergency status of the operation. Missing data were addressed through multiple imputation, and feature selection was performed using univariate analysis and clinical judgment. The model was validated using cross-validation and assessed for performance using ROC AUC and precision-recall AUC metrics.ResultsThe logistic regression model demonstrated high predictive accuracy, with an ROC AUC of 0.978 and a precision-recall AUC of 0.958. Significant predictors of 30-day in-hospital mortality included emergency status of the operation (OR: 1.56), preoperative prothrombin time (PT/INR) (OR: 1.53), potassium levels (OR: 1.49), body mass index (BMI) (OR: 1.37), serum sodium (OR: 1.11), creatinine levels (OR: 1.04), and albumin levels (OR: 0.85).ConclusionThis study successfully developed and validated a logistic regression model to predict 30-day in-hospital mortality using comprehensive perioperative data. The model’s high predictive accuracy and reliance on routinely collected clinical and laboratory data enhance its feasibility for integration into existing clinical workflows, providing real-time risk assessments to healthcare providers. Future research should focus on external validation in diverse clinical settings and prospective studies to assess the practical impact of this predictive model.