Development of Multicenter Deep Learning Models for Predicting Surgical Complexity and Surgical Site Infection in Abdominal Wall Reconstruction, a Pilot Study.

Objective: Hernia recurrence and surgical site infection (SSI) are grave complications in Abdominal Wall Reconstruction (AWR). This study aimed to develop multicenter deep learning models (DLMs) developed for predicting surgical complexity, using Component Separation Technique (CST) as a surrogate, and the risk of surgical site infections (SSI) in AWR, using preoperative computed tomography (CT) images. Methods: Multicenter models were created using deidentified CT images from two tertiary AWR centers. The models were developed with ResNet-18 architecture. Model performance was reported as accuracy and AUC. Results: The CST model underperformed with an AUC of 0.569, while the SSI model exhibited strong performance with an AUC of 0.898. Conclusion: The study demonstrated the successful development of a multicenter DLM for SSI prediction in AWR, highlighting the impact of patient factors over surgical practice variability in predicting SSIs with DLMs. The CST model's prediction remained challenging, which we hypothesize reflects the subjective nature of surgical decisions and varying institutional practices. Our findings underscore the potential of AI-enhanced surgical risk calculators to risk stratify patients and potentially improve patient outcomes.