BACKGROUND: Postdischarge venous thromboembolism (pdVTE) is a life-threatening complication following resection for pancreatic cancer (PC). While national guidelines recommend extended chemoprophylaxis for all, adherence is low and ranges from 1.5 to 44%. Predicting a patient's pdVTE risk would enable a more tailored approach to extended chemoprophylaxis, better balancing the cost and risks of overtreatment. We aimed to demonstrate the feasibility of using machine learning models to predict pdVTE.

PATIENTS AND METHODS: We analyzed data from patients undergoing pancreatectomy for PC using the National Surgical Quality Improvement Program database between 2014 and 2020. Predictive classification models were trained and independently tested on features available at the time of discharge including demographics, clinical, laboratory, cancer, and surgery-specific variables. We developed and compared logistic regression (LR), decision tree (DT), random forest (RF), and gradient boosting (GB) models to predict the development of pdVTE. Model performance and feature importance were evaluated.

RESULTS: The study included a total of 51,916 patients, with 743 (1.4%) experiencing pdVTE. The best-performing GB, RF, and DT models achieved area under the curve (AUC) scores of 0.83, 0.80, and 0.80, respectively, demonstrating superior performance compared with the traditional LR (AUC = 0.72) model. The GB model achieved a specificity of 99%, sensitivity of 0.40%, and area under the precision recall curve of 0.34. The most important variables were intraoperative antibiotic use, blood transfusion, length of stay, and postoperative infections.

CONCLUSIONS: Machine learning models can reliably identify patients who are at high risk for pdVTE. Such models should be used to inform prescription of extended VTE prophylaxis.