Accurate prediction of postoperative complications can inform shared decisions between patients and surgeons regarding the appropriateness of surgery, preoperative risk-reduction strategies, and postoperative resource use. Traditional predictive analytic tools are hindered by suboptimal performance and usability. We hypothesized that novel deep learning techniques would outperform logistic regression models in predicting postoperative complications. In a single-center longitudinal cohort of 43,943 adult patients undergoing 52,529 major inpatient surgeries, deep learning yielded greater discrimination than logistic regression for all nine complications. Predictive performance was strongest when leveraging the full spectrum of preoperative and intraoperative physiologic time-series electronic health record data. A single multi-task deep learning model yielded greater performance than separate models trained on individual complications. Integrated gradients interpretability mechanisms demonstrated the substantial importance of missing data. Interpretable, multi-task deep neural networks made accurate, patient-level predictions that harbor the potential to augment surgical decision-making.
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