Machine learning adjusted sequential CUSUM-analyses are superior to cross-sectional analysis of excess mortality after surgery

• Many complications arise from avoidable human errors. • CUSUM identifies systemic issues quickly, with roots in industrial applications. • AI risk-adjusted CUSUM improves post-surgical mortality detection by adjusting for patient risk. • This approach allows fairer and faster assessments across diverse patient populations. • Continuous monitoring can lead to better outcomes and healthcare efficiency. The assessment of clinical outcome quality, particularly in surgery, is crucial for healthcare improvement. Traditional cross-sectional analyses often fall short in timely and systematic identification of clinical quality issues. This study explores the efficacy of machine learning adjusted sequential CUSUM (Cumulative Sum) analyses in monitoring post-surgical mortality. Utilizing the Global Open Source Severity of Illness Score (GOSSIS) dataset involving 91,714 patient records from 147 hospitals, this study involved the development of a machine learning model for mortality using a modified LightGBM algorithm. With this, sequential and cross sectional quality monitoring was simulated and compared. The modified LightGBM model demonstrated superior predictive accuracy (ROC AUC of 0.88). Simulations revealed that the AI risk-adjusted CUSUM required fewer patient outcome alterations to detect atypical trends compared to standard methods. The AI risk-adjusted CUSUM analysis represents a significant advancement in monitoring clinical outcome quality in healthcare, especially in surgery. Its ability to detect minor discrepancies in mortality rates with greater sensitivity and specificity positions it as a valuable tool for healthcare providers. This approach could lead to earlier interventions and improved patient care.